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Eleftheriades M, Vousoura E, Eleftheriades A, Pervanidou P, Zervas IM, Chrousos G, Vlahos NF, Sotiriadis A. Physical Health, Media Use, Stress, and Mental Health in Pregnant Women during the COVID-19 Pandemic. Diagnostics (Basel) 2022; 12:diagnostics12051125. [PMID: 35626281 PMCID: PMC9140022 DOI: 10.3390/diagnostics12051125] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 04/25/2022] [Accepted: 04/27/2022] [Indexed: 02/01/2023] Open
Abstract
Background: The COVID-19 pandemic has led to significant changes in the care of pregnant women and their fetuses. Emerging data show elevated depression and anxiety symptoms among pregnant women. Aims: The purpose of this article is to investigate the psychological and behavioral impact of the COVID-19 pandemic on pregnant women in Greece during the first national lockdown. Methods: We used a cross-sectional, anonymous survey to collect data in two fetal medicine clinics in the largest urban centers of Greece during the months of April and May 2020. The questionnaire was largely based on the CoRonavIruS Health Impact Survey (CRISIS), and assessed sociodemographic characteristics, general health and obstetric data and COVID-19-related worries and life changes. Mood symptoms, substance use and lifestyle behaviors were assessed at two time points (3 months prior to the pandemic and the 2 weeks before taking the survey), while perceived stress was measured with the perceived stress scale (PSS-14). Results: A total of 308 pregnant women (Mage = 34.72), with a mean gestation of 21.19 weeks participated in the study. Over one-third of the women found COVID-19 restrictions stressful, and their highest COVID-19-related worry was having to be isolated from their baby. Mean PSS-14 score was 21.94, suggesting moderate stress. The strongest predictors of stress were physical and mental health status before COVID-19 and having experienced a stressful life event during their pregnancy. Compared to 3 months before the pandemic, women reported higher scores on mood symptoms (p < 0.001), TV use (p = 0.01) and social media use (p = 0.031) in the last 2 weeks before taking the survey. Conclusion: Our study provides important preliminary evidence of the negative impact of the COVID-19 pandemic and the lockdown on pregnant women’s well-being and functioning.
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Affiliation(s)
- Makarios Eleftheriades
- Second Department of Obstetrics and Gynecology, School of Medicine, National and Kapodistrian University of Athens, Aretaieion Hospital, 11528 Athens, Greece;
- Correspondence:
| | - Eleni Vousoura
- Department of Psychology, National and Kapodistrian University of Athens, 15780 Athens, Greece;
- First Department of Psychiatry, School of Medicine, National and Kapodistrian University of Athens, “Aiginiteion” Hospital, 11528 Athens, Greece;
| | - Anna Eleftheriades
- Postgraduate Programme in Fetal Maternal Medicine, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece;
| | - Panagiota Pervanidou
- Unit of Developmental and Behavioral Pediatrics, First Department of Pediatrics, National and Kapodistrian University of Athens, Aghia Sophia Children’s Hospital, 11527 Athens, Greece; (P.P.); (G.C.)
| | - Iannis M. Zervas
- First Department of Psychiatry, School of Medicine, National and Kapodistrian University of Athens, “Aiginiteion” Hospital, 11528 Athens, Greece;
| | - George Chrousos
- Unit of Developmental and Behavioral Pediatrics, First Department of Pediatrics, National and Kapodistrian University of Athens, Aghia Sophia Children’s Hospital, 11527 Athens, Greece; (P.P.); (G.C.)
| | - Nikolaos F. Vlahos
- Second Department of Obstetrics and Gynecology, School of Medicine, National and Kapodistrian University of Athens, Aretaieion Hospital, 11528 Athens, Greece;
| | - Alexandros Sotiriadis
- Second Department of Obstetrics and Gynecology, School of Medicine, Aristotle University of Thessaloniki, “Ippokrateion” Hospital, 54642 Thessaloniki, Greece;
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152
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Eakley R, Lyndon A. Antidepressant use During Pregnancy: Knowledge, Attitudes, and Decision-Making of Patients and Providers. J Midwifery Womens Health 2022; 67:332-353. [PMID: 35536040 DOI: 10.1111/jmwh.13366] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 03/22/2022] [Accepted: 03/30/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Despite the risks associated with untreated perinatal depression and anxiety, both patients and clinicians are less likely to follow evidence-based guidelines including the use of antidepressants during pregnancy. The aim of this integrative review was to describe the perspectives of both patients and prescribing health care providers regarding the use of antidepressants during pregnancy. METHODS We performed a literature search in PubMed, CINAHL, ProQuest Central, and PsychINFO. Inclusion criteria were English language, original peer-reviewed research published within the previous 10 years that described perspectives regarding the use of antidepressants of pregnant patients or prescribing providers during pregnancy. Studies were excluded if their focus was on screening practices, treatment guidelines, or evaluation of decision support tool; medication or treatment broadly; bipolar disorder or serious mental illness; or they did not provide patient or provider perspective. This review was limited to professionals with scopes of practice that include prescriptive authority (eg, physicians, advanced practices nurses, midwives). Included articles were critically appraised and read in an iterative process to extract methodological details and synthesize findings. RESULTS Nineteen studies met criteria for inclusion and varied by design, sample, and quality. Together, the reviewed articles suggest that patients and prescribing providers hold a range of beliefs regarding the safety of antidepressant during pregnancy. Patients and providers appear to value different sources of information and varied in awareness of the negative impacts of untreated depression and anxiety during pregnancy. Many patients report dissatisfaction with available information and distress throughout the decision-making experience. Notably, patients and providers had incongruent perceptions of the others' experience. DISCUSSION Inconsistencies between knowledge, attitudes, and decision-making highlight the need for improved dissemination of evidence-based treatments and support increased training for psychopharmacology during pregnancy. Efforts to reduce patient distress regarding their decisions, such as adequate time and information, are indicated.
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Affiliation(s)
- Rachel Eakley
- Rory Meyers College of Nursing, New York University, New York, New York
| | - Audrey Lyndon
- Rory Meyers College of Nursing, New York University, New York, New York
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153
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Proximity and density of unconventional natural gas wells and mental illness and substance use among pregnant individuals: An exploratory study in Canada. Int J Hyg Environ Health 2022; 242:113962. [DOI: 10.1016/j.ijheh.2022.113962] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 02/24/2022] [Accepted: 03/12/2022] [Indexed: 11/23/2022]
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154
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Midwives’ experiences of supporting women's mental health: a mixed-method study. Midwifery 2022; 111:103368. [DOI: 10.1016/j.midw.2022.103368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 03/07/2022] [Accepted: 05/09/2022] [Indexed: 11/23/2022]
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155
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Fairbrother N, Albert A, Collardeau F, Keeney C. The Childbirth Fear Questionnaire and the Wijma Delivery Expectancy Questionnaire as Screening Tools for Specific Phobia, Fear of Childbirth. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084647. [PMID: 35457513 PMCID: PMC9028446 DOI: 10.3390/ijerph19084647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 03/14/2022] [Accepted: 04/02/2022] [Indexed: 12/04/2022]
Abstract
Background: Perinatal anxiety and related disorders are common (20%), distressing and impairing. Fear of childbirth (FoB) is a common type of perinatal anxiety associated with negative mental health, obstetrical, childbirth and child outcomes. Screening can facilitate treatment access for those most in need. Objectives: The purpose of this research was to evaluate the accuracy of the Childbirth Fear Questionnaire (CFQ) and the Wijma Delivery Expectations Questionnaire (W-DEQ) of FoB as screening tools for a specific phobia, FoB. Methods: A total of 659 English-speaking pregnant women living in Canada and over the age of 18 were recruited for the study. Participants completed an online survey of demographic, current pregnancy and reproductive history information, as well as the CFQ and the W-DEQ, and a telephone interview to assess specific phobia FoB. Results: Symptoms meeting full and subclinical diagnostic criteria for a specific phobia, FoB, were reported by 3.3% and 7.1% of participants, respectively. The W-DEQ met or exceeded the criteria for a “good enough” screening tool across several analyses, whereas the CFQ only met these criteria in one analysis and came close in three others. Conclusions: The W-DEQ demonstrated high performance as a screening tool for a specific phobia, FoB, with accuracy superior to that of the CFQ. Additional research to ensure the stability of these findings is needed.
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Affiliation(s)
- Nichole Fairbrother
- Department of Family Practice, University of British Columbia, Vancouver, BC V6T 1Z4, Canada;
- Correspondence: ; Tel.: +1-250-0519-5390 (ext. 36439)
| | - Arianne Albert
- Women’s Health Research Institute, Vancouver, BC V6H 2N9, Canada;
| | - Fanie Collardeau
- Department of Psychology, University of Victoria, Victoria, BC V8P 5C2, Canada;
| | - Cora Keeney
- Department of Family Practice, University of British Columbia, Vancouver, BC V6T 1Z4, Canada;
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156
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Shen Q, Huang CR, Rong L, Ju S, Redding SR, Ouyang YQ, Wang R. Effects of needs-based education for prenatal anxiety in advanced multiparas: a randomized controlled trial. BMC Pregnancy Childbirth 2022; 22:301. [PMID: 35395734 PMCID: PMC8994345 DOI: 10.1186/s12884-022-04620-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 03/22/2022] [Indexed: 11/12/2022] Open
Abstract
Background Prenatal anxiety is a common concern which may have adverse effects on maternal and infant health outcomes. Studies addressing needs-based education interventions for prenatal anxiety are limited. Aim To explore the effects of needs-based education on alleviating prenatal anxiety among advanced multiparas when compared with routine prenatal health education. Methods A total of 86 advanced multiparas were randomized into the intervention group (n = 43) or the control group (n = 43) in this study. The control group received routine prenatal care. The intervention group received five needs-based education programs presented by trained researchers. The Pregnancy-related Anxiety Questionnaire was used to evaluate changes in anxiety level of participants. Concurrent physiological parameters, including blood pressure, heart rate and non-stress test were also measured. Results Scores on the Pregnancy-related Anxiety Questionnaire of the intervention group were significantly lower than those of the control group (t = 4.21, P < 0.05). Systolic blood pressure (t = 3.64, P < 0.05) and heart rate (t = 2.39, P < 0.05) of the intervention group were also significantly lower than the control group whereas no differences were noted in diastolic blood pressure and non-stress test. Conclusion A needs-based education program is an effective intervention strategy to allay prenatal anxiety in advanced multiparas. Trial registration The trial was retrospectively registered in the Chinese Clinical Trial Registry as number ChiCTR2100047552.
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Affiliation(s)
- Quan Shen
- School of Nursing, Wuhan University, No.115, Donghu Road, Wuchang District, Wuhan, 430071, China
| | - Can-Ran Huang
- School of Nursing, Wuhan University, No.115, Donghu Road, Wuchang District, Wuhan, 430071, China
| | - Liu Rong
- School of Nursing, Wuhan University, No.115, Donghu Road, Wuchang District, Wuhan, 430071, China
| | - Shan Ju
- School of Nursing, Wuhan University, No.115, Donghu Road, Wuchang District, Wuhan, 430071, China
| | | | - Yan-Qiong Ouyang
- School of Nursing, Wuhan University, No.115, Donghu Road, Wuchang District, Wuhan, 430071, China.
| | - Rong Wang
- Nursing Department of East Campus, Renming Hospital of Wuhan University, Gaoxin Sixth Road, Jiangxia District, Wuhan, 430071, China.
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Goetzl L, Darbinian N, Merabova N, Devane LC, Ramamoorthy S. Gestational Age Variation in Human Placental Drug Transporters. Front Pharmacol 2022; 13:837694. [PMID: 35462922 PMCID: PMC9019509 DOI: 10.3389/fphar.2022.837694] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 01/24/2022] [Indexed: 12/29/2022] Open
Abstract
Patient and providers’ fear of fetal exposure to medications may lead to discontinuation of treatment, disease relapse, and maternal morbidity. Placental drug transporters play a critical role in fetal exposure through active transport but the majority of data are limited to the 3rd trimester, when the majority of organogenesis has already occurred. Our objective was to define gestational age (GA) dependent changes in protein activity, expression and modifications of five major placental drug transporters: SERT, P-gp, NET, BCRP and MRP3. Apical brush border membrane fractions were prepared from fresh 1st, 2nd and 3rd trimester human placentas collected following elective pregnancy termination or planned cesarean delivery. A structured maternal questionnaire was used to identify maternal drug use and exclude exposed subjects. Changes in placental transporter activity and expression relative to housekeeping proteins were quantified. There was evidence for strong developmental regulation of SERT, NET, P-gp, BCRP and MRP3. P-gp and BCRP decreased with gestation (r = −0.72, p < 0.001 and r = −0.77, p < 0.001, respectively). Total SERT increased with gestation but this increase was due to a decrease in SERT cleavage products across trimesters. Uncleaved SERT increased with GA (r = 0.89, p < 0.001) while cleaved SERT decreased with GA (r = −0.94, p < 0.001). Apical membrane NET overall did not appear to be developmentally regulated (r = −0.08, p = 0.53). Two forms of MRP3 were identified; the 50 kD form did not change across GA; the 160 kD form was steady in the 1st and 2nd trimester and increased in the 3rd trimester (r = 0.24, p = 0.02). The 50 kD form was expressed at higher levels. The observed patterns of SERT, NET P-gp, BCRP and MRP3 expression and activity may be associated with transporter activity or decreased placental permeability in the 1st trimester to transporter specific substrates including commonly used psychoactive medications such as anti-depressants, anti-psychotics, and amphetamines, while transport of nutrients and serotonin is important in the 1st trimester. Overall these observations are consistent with a strong protective effect during organogenesis. 3rd trimester estimates of fetal exposure obtained from cord blood likely significantly overestimate early fetal exposure to these medications at any fixed maternal dose.
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158
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Ade-Ojo IP, Dada MU, Adeyanju TB. Comparison of Anxiety and Depression Among HIV-Positive and HIV-Negative Pregnant Women During COVID-19 Pandemic in Ekiti State, Southwest Nigeria. Int J Gen Med 2022; 15:4123-4130. [PMID: 35465305 PMCID: PMC9020505 DOI: 10.2147/ijgm.s362225] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 04/06/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Idowu Pius Ade-Ojo
- Department of Obstetrics & Gynecology, Ekiti State University, Ado-Ekiti, Ekiti State, Nigeria
- Correspondence: Idowu Pius Ade-Ojo, Department of Obstetrics & Gynecology, Ekiti State University, PMB 5363, Ado-Ekiti, Ekiti State, Nigeria, Tel +234 8033886173, Email
| | - Mobolaji Usman Dada
- Department of Psychiatry, Ekiti State University, Ado-Ekiti, Ekiti State, Nigeria
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Seefeld L, Mojahed A, Thiel F, Schellong J, Garthus-Niegel S. Preferences and Barriers to Counseling for and Treatment of Intimate Partner Violence, Depression, Anxiety, and Posttraumatic Stress Disorder Among Postpartum Women: Study Protocol of the Cross-Sectional Study INVITE. Front Psychiatry 2022; 13:836350. [PMID: 35422719 PMCID: PMC9001846 DOI: 10.3389/fpsyt.2022.836350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 03/03/2022] [Indexed: 11/13/2022] Open
Abstract
The cross-sectional study INVITE (INtimate partner VIolence care and Treatment prEferences in postpartum women) aims to examine treatment and counseling preferences and barriers in relation to the experience of intimate partner violence (IPV), depression and anxiety, and (childbirth-related) posttraumatic stress disorder (PTSD) among postpartum women in Dresden, Germany. Currently, the INVITE study consists of an interim sample of N = 1,787 participants with n = 891 completed interviews. Recruitment is ongoing, targeting a community sample of at least N = 4,000 women who complete various quantitative questionnaires via telephone interviews at 3-4 months postpartum. The differences in rates of IPV, postpartum depression and anxiety, and/or (childbirth-related) PTSD as well as treatment and counseling preferences and barriers between affected and non-affected women will be assessed. Further, predisposing variables, past and present stress exposure, enabling resources, as well as past and present health will be examined as predictors of service preferences and barriers. In this study protocol, the theoretical background, methods, as well as preliminary results regarding sociodemographic characteristics and birth-related factors of the interim sample are presented and discussed in terms of their socio-political relevance. Simultaneously assessing IPV, postpartum depression and anxiety, and (childbirth-related) PTSD will facilitate exploring comorbidities and concomitant special needs of affected women. Results of the INVITE study will therefore set the ground for well-aimed development and improvement of treatment and counseling services for the respective target groups by informing health care professionals and policy makers about specific preferences and barriers to treatment. This will yield the possibility to tailor services to the needs of postpartum women.
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Affiliation(s)
- Lara Seefeld
- Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Amera Mojahed
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Freya Thiel
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
- Institute for Systems Medicine (ISM), Faculty of Medicine, Medical School Hamburg, Hamburg, Germany
| | - Julia Schellong
- Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Susan Garthus-Niegel
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
- Institute for Systems Medicine (ISM), Faculty of Medicine, Medical School Hamburg, Hamburg, Germany
- Department of Child Health and Development, Norwegian Institute of Public Health, Oslo, Norway
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160
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Identifying postnatal anxiety: comparison of self-identified and self-reported anxiety using the Edinburgh Postnatal Depression Scale. BMC Pregnancy Childbirth 2022; 22:180. [PMID: 35241007 PMCID: PMC8896366 DOI: 10.1186/s12884-022-04437-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 01/27/2022] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Identifying women with perinatal anxiety is important in order to provide timely support and prevent adverse outcomes. Self-report instruments are commonly used in maternity settings. An alternative is to ask women directly whether they self-identify as having anxiety. We examine the agreement between self-reported and self-identified anxiety at 3 months postpartum and compare the characteristics of women with self-reported and self-identified anxiety. METHODS A secondary analysis of national maternity surveys conducted in 2014 in England and Northern Ireland was conducted. Self-reported anxiety was assessed using the Edinburgh Postnatal Depression Scale anxiety subscale (EPDS-3A). Agreement between self-reported and self-identified anxiety was measured using Cohen's kappa. Logistic regression was used to identify characteristics of women in each group. RESULTS In our sample of 6752 women, 14.2% had self-reported anxiety, 5.9% had self-identified anxiety and 3.5% were positive on both measures. Among those with self-identified anxiety, 58.1% also had self-reported anxiety. Of those with self-reported anxiety, 24.4% also had self-identified anxiety. Statistical agreement between the two measures was minimal with Cohen's kappa 0.283 at an EPDS-3A threshold of ≥6. Among both self-identified and self-reported anxiety groups, psychological factors were the strongest associated factors. Women with self-reported anxiety had higher odds of being from Northern Ireland (OR 1.81); having a mixed or unhappy reaction to the pregnancy (OR 1.65); living without a partner (aOR 1.37); and antenatal depression (aOR 1.32). Women with self-identified anxiety had higher odds of physical problems (OR 1.84); and being of Black or minority ethnicity (OR 0.39). CONCLUSIONS Asking postnatal women directly whether they self-identify as having anxiety identifies a different group of women from those who score highly on self-report measures. Women with self-identified anxiety may benefit from further follow-up and support.
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161
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Logue TC, Wen T, Monk C, Guglielminotti J, Huang Y, Wright JD, D'Alton ME, Friedman AM. Trends in and complications associated with mental health condition diagnoses during delivery hospitalizations. Am J Obstet Gynecol 2022; 226:405.e1-405.e16. [PMID: 34563500 DOI: 10.1016/j.ajog.2021.09.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 09/14/2021] [Accepted: 09/17/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Mental health conditions during delivery hospitalizations are not well characterized. OBJECTIVE This study aimed to characterize the prevalence of maternal mental health condition diagnoses and associated risk during delivery hospitalizations in the United States. STUDY DESIGN The 2000 to 2018 National Inpatient Sample was used for this repeated cross-sectional analysis. Delivery hospitalizations of women aged 15 to 54 years with and without mental health condition diagnoses, including depressive disorder, anxiety disorder, bipolar spectrum disorder, and schizophrenia spectrum disorder, were identified. Temporal trends in mental health condition diagnoses during delivery hospitalizations were determined using the National Cancer Institute's Joinpoint Regression Program to estimate the average annual percent change with 95% confidence intervals. The trends in chronic conditions associated with mental health condition diagnoses, including asthma, pregestational diabetes mellitus, chronic hypertension, obesity, and substance use, were analyzed. The association between mental health conditions and the following adverse outcomes was determined: (1) severe maternal morbidity, (2) preeclampsia or gestational hypertension, (3) preterm delivery, (4) postpartum hemorrhage, (5) cesarean delivery, and (6) maternal mortality. Regression models for each outcome were performed with unadjusted and adjusted risk ratios as measures of effects. RESULTS Of 73,109,791 delivery hospitalizations, 2,316,963 (3.2%) had ≥1 associated mental health condition diagnosis. The proportion of delivery hospitalizations with a mental health condition increased from 0.6% in 2000 to 7.3% in 2018 (average annual percent change, 11.4%; 95% confidence interval, 10.3%-12.6%). Among deliveries in women with a mental health condition diagnosis, chronic health conditions, including asthma, pregestational diabetes mellitus, chronic hypertension, obesity, and substance use, increased from 14.9% in 2000 to 38.5% in 2018. Deliveries to women with a mental health condition diagnosis were associated with severe maternal morbidity (risk ratio, 1.88; 95% confidence interval, 1.86-1.90), preeclampsia and gestational hypertension (risk ratio, 1.59; 95% confidence interval, 1.58-1.60), preterm delivery (risk ratio, 1.35; 95% confidence interval, 1.35-1.36), postpartum hemorrhage (risk ratio, 1.37; 95% confidence interval, 1.36-1.38), cesarean delivery (risk ratio, 1.20; 95% confidence interval, 1.20-1.20), and maternal death (risk ratio, 1.31; 95% confidence interval, 1.12-1.56). The increased risk was retained in adjusted models. CONCLUSION The proportion of delivery hospitalizations with mental health condition diagnoses increased significantly throughout the study period. Mental health condition diagnoses were associated with other underlying chronic health conditions and a modestly increased risk of a range of adverse outcomes. The findings suggested that mental health conditions are an important risk factor in adverse maternal outcomes.
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Affiliation(s)
- Teresa C Logue
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY
| | - Timothy Wen
- Department of Obstetrics and Gynecology, University of California San Francisco, San Francisco, CA
| | - Catherine Monk
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY; New York State Psychiatric Institute, New York, NY
| | - Jean Guglielminotti
- Department of Anesthesiology, Columbia University Irving Medical Center, New York, NY
| | - Yongmei Huang
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY
| | - Jason D Wright
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY
| | - Mary E D'Alton
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY
| | - Alexander M Friedman
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY.
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Ou CH, Hall WA, Rodney P, Stremler R. Correlates of Canadian mothers' anger during the postpartum period: a cross-sectional survey. BMC Pregnancy Childbirth 2022; 22:163. [PMID: 35227249 PMCID: PMC8883707 DOI: 10.1186/s12884-022-04479-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 01/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although some women experience anger as a mood problem after childbirth, postpartum anger has been neglected by researchers. Mothers' and infants' poor sleep quality during the postpartum period has been associated with mothers' depressive symptoms; however, links between mothers' sleep quality and postpartum anger are unclear. This study aimed to determine proportions of women with intense anger, depressive symptoms, and comorbid intense anger and depressive symptoms, and to examine mothers' and infants' sleep quality as correlates of postpartum anger. METHODS This cross-sectional survey study was advertised as an examination of mothers' and babies' sleep. Women, with healthy infants between 6 and 12 months of age, were recruited using community venues. The survey contained validated measures of sleep quality for mothers and infants, and fatigue, social support, anger, depressive symptoms, and cognitions about infant sleep. RESULTS 278 women participated in the study. Thirty-one percent of women (n = 85) reported intense anger (≥ 90th percentile on State Anger Scale) while 26% (n = 73) of mothers indicated probable depression (>12 on Edinburgh Postnatal Depression Scale). Over half of the participants rated their sleep as poor (n = 144, 51.8%). Using robust regression analysis, income (β = -0.11, p < 0.05), parity (β = 0.2, p < 0.01), depressive symptoms (β = 0.22, p < 0.01), and mothers' sleep quality (β = 0.10, p < 0.05), and anger about infant sleep (β = 0.25, p < 0.01) were significant predictors of mothers' anger. CONCLUSIONS Mothers' sleep quality and anger about infant sleep are associated with their state anger. Clinicians can educate families about sleep pattern changes during the perinatal time frame and assess women's mood and perceptions of their and their infants' sleep quality in the first postpartum year. They can also offer evidence-based strategies for improving parent-infant sleep. Such health promotion initiatives could reduce mothers' anger and support healthy sleep.
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Affiliation(s)
- Christine Hk Ou
- School of Nursing, University of Victoria, 3800 Finnerty Road, HSD Building, Room A402a, Victoria, British Columbia, V8P 5C2, Canada. .,Institute of Aging and Lifelong Health, University of Victoria, Victoria, Canada.
| | - Wendy A Hall
- School of Nursing, University of British Columbia, 2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada
| | - Paddy Rodney
- School of Nursing, University of British Columbia, 2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada
| | - Robyn Stremler
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Toronto, ON, M5T 1P8, Canada
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Fairbrother N, Collardeau F, Albert A, Stoll K. Screening for Perinatal Anxiety Using the Childbirth Fear Questionnaire: A New Measure of Fear of Childbirth. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042223. [PMID: 35206412 PMCID: PMC8872365 DOI: 10.3390/ijerph19042223] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 02/01/2022] [Accepted: 02/02/2022] [Indexed: 12/27/2022]
Abstract
Fear of childbirth affects as many as 20% of pregnant people, and has been associated with pregnancy termination, prolonged labour, increased risk of emergency and elective caesarean delivery, poor maternal mental health, and poor maternal-infant bonding. Currently available measures of fear of childbirth fail to fully capture pregnant people’s childbirth-related fears. The purpose of this research was to develop a new measure of fear of childbirth (the Childbirth Fear Questionnaire; CFQ) that would address the limitations of existing measures. The CFQ’s psychometric properties were evaluated through two studies. Participants for Study 1 were 643 pregnant people residing in Canada, the United States, and the United Kingdom, with a mean age of 29.0 (SD = 5.1) years, and 881 pregnant people residing in Canada, with a mean age of 32.9 (SD = 4.3) years for Study 2. In both studies, participants completed a set of questionnaires, including the CFQ, via an online survey. Exploratory factor analysis in Study 1 resulted in a 40-item, 9-factor scale, which was well supported in Study 2. Both studies provided evidence of high internal consistency and convergent and discriminant validity. Study 1 also provided evidence that the CFQ detects group differences between pregnant people across mode of delivery preference and parity. Study 2 added to findings from Study 1 by providing evidence for the dimensional structure of the construct of fear of childbirth, and measurement invariance across parity groups (i.e., the measurement model of the CFQ was generalizable across parity groups). Estimates of the psychometric properties of the CFQ across the two studies provided evidence that the CFQ is psychometrically sound, and currently the most comprehensive measure of fear of childbirth available. The CFQ covers a broad range of domains of fear of childbirth and can serve to identify specific fear domains to be targeted in treatment.
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Affiliation(s)
- Nichole Fairbrother
- Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z4, Canada;
- Correspondence:
| | - Fanie Collardeau
- Department of Psychology, Faculty of Social Sciences, University of Victoria, Victoria, BC V8P 5C2, Canada;
| | - Arianne Albert
- Women’s Health Research Institute, Vancouver, BC V6H 2N9, Canada;
| | - Kathrin Stoll
- Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z4, Canada;
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Abstract
Introduction Psychotic illness, although is rare, has been reported in the perinatal period. Individuals diagnosed with psychotic illness tend to first exhibit psychotic-like experiences (PLEs), defined as subclinical psychotic symptoms that occur outside the context of sleep or drug use. However, there is a paucity of empirical data on PLEs in pregnancy to advance scholarly discourse and support professional practice. The current study investigated the prevalence and correlates of PLEs among pregnant women in Ghana, a West African state. Design A cross-sectional survey design was used to collect data from 702 pregnant women who responded to measures of PLEs, COVID-19 concerns and behavioral maladies such as anxiety and depressive symptoms. Descriptive and inferential statistics, namely chi square, exploratory factor analysis, MANOVA and multinomial logistic regression were used to analyze the data. Results The results showed that 54.2%, 27.3% and 18.5% of participants were at no/low, moderate and high risk for psychosis, respectively. A total of 44.4% participants were not distressed by PLEs, whereas 32.2% and 23.4% were a bit/quite and very distressed, respectively. Psychosis risk was elevated among pregnant women who were more concerned about the COVID-19 effects, scored high in suicidal ideation, depressive symptoms and sleep difficulties. Conclusion The study showed that psychosis risk is present in pregnancy. Implications Screening for psychosis risk in pregnancy should be prioritized for pregnant women with behavioral maladies, including suicidal tendencies, depressive symptoms, sleep difficulties and heightened concerns about COVID-19.
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Evans K, Rennick-Egglestone S, Cox S, Kuipers Y, Spiby H. Remotely Delivered Interventions to Support Women With Symptoms of Anxiety in Pregnancy: Mixed Methods Systematic Review and Meta-analysis. J Med Internet Res 2022; 24:e28093. [PMID: 35166688 PMCID: PMC8889484 DOI: 10.2196/28093] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 06/03/2021] [Accepted: 11/19/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Symptoms of anxiety are common in pregnancy, with severe symptoms associated with negative outcomes for women and babies. Low-level psychological therapy is recommended for women with mild to moderate anxiety, with the aim of preventing an escalation of symptoms and providing coping strategies. Remotely delivered interventions have been suggested to improve access to treatment and support and provide a cost-effective, flexible, and timely solution. OBJECTIVE This study identifies and evaluates remotely delivered, digital, or web-based interventions to support women with symptoms of anxiety during pregnancy. METHODS This mixed methods systematic review followed a convergent segregated approach to synthesize qualitative and quantitative data. The ACM Digital Library, Allied and Complementary Medicine Database, Applied Social Sciences Index and Abstracts, Centre for Reviews and Dissemination database, the Cochrane Central Register of Controlled Trials, the Cochrane Library, CINAHL, Embase, Health Technology Assessment Library, IEEE Xplore, Joanna Briggs Institute, Maternity and Infant Care, MEDLINE, PsycINFO, and the Social Science Citation Index were searched in October 2020. Quantitative or qualitative primary research that included pregnant women and evaluated remotely delivered interventions reporting measures of anxiety, fear, stress, distress, women's views, and opinions were included. RESULTS Overall, 3 qualitative studies and 14 quantitative studies were included. Populations included a general antenatal population and pregnant women having anxiety and depression, fear of childbirth, insomnia, and preterm labor. Interventions included cognitive behavioral therapy, problem solving, mindfulness, and educational designs. Most interventions were delivered via web-based platforms, and 62% (8/13) included direct contact from trained therapists or coaches. A meta-analysis of the quantitative data found internet-based cognitive behavioral therapy and facilitated interventions showed a beneficial effect in relation to the reduction of anxiety scores (standardized mean difference -0.49, 95% CI -0.75 to -0.22; standardized mean difference -0.48, 95% CI -0.75 to -0.22). Due to limitations in the amount of available data and study quality, the findings should be interpreted with caution. Synthesized findings found some evidence to suggest that interventions are more effective when women maintain regular participation which may be enhanced by providing regular contact with therapists or peer support, appropriate targeting of interventions involving components of relaxation and cognitive-based skills, and providing sufficient sessions to develop new skills without being too time consuming. CONCLUSIONS There is limited evidence to suggest that women who are pregnant may benefit from remotely delivered interventions. Components of interventions that may improve the effectiveness and acceptability of remotely delivered interventions included providing web-based contact with a therapist, health care professional, or peer community. Women may be more motivated to complete interventions that are perceived as relevant or tailored to their needs. Remote interventions may also provide women with greater anonymity to help them feel more confident in disclosing their symptoms.
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Affiliation(s)
- Kerry Evans
- School of Health Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Stefan Rennick-Egglestone
- Institute of Mental Health, School of Health Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Serena Cox
- School of Health Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Yvonne Kuipers
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, United Kingdom
| | - Helen Spiby
- School of Health Sciences, University of Nottingham, Nottingham, United Kingdom
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Lau Y, Yen KY, Wong SH, Cheng JY, Cheng LJ. Effect of digital cognitive behavioral therapy on psychological symptoms among perinatal women in high income-countries: A systematic review and meta-regression. J Psychiatr Res 2022; 146:234-248. [PMID: 34774299 DOI: 10.1016/j.jpsychires.2021.11.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 09/11/2021] [Accepted: 11/04/2021] [Indexed: 10/19/2022]
Abstract
Several reviews focused on the use of digital cognitive behavioral therapy (CBT) across different populations. This review synthesized randomized controlled trials (RCTs) that evaluated the effectiveness of digital CBT on psychological symptoms (depression, anxiety, and stress symptoms). An extensive search was conducted in 10 databases from inception until August 29, 2021. A meta-analysis using a random-effects model was performed using Hedges' g. The potential sources of heterogeneity were explored through subgroup analyses and meta-regression analysis. A total of 18 RCTs in 2514 perinatal women were identified from over 23 countries. The sample size ranged from 25 to 910. Meta-analyses showed that digital CBT significantly reduced depression (g = -0.56, 95% CI: -0.85, -0.27, I2 = 84.81%, p < 0.001), anxiety (g = -0.30, 95% CI: -0.44, -0.17, I2 = 0%, p < 0.001), and stress (g = -0.75, 95% CI: -0.95, -0.56, I2 = 0%, p < 0.001) symptoms at post-intervention and stress symptoms at follow-up (g = -0.52, 95% CI: -0.93, -0.11, I2 = 0%, p = 0.01) compared with those in the control group. Subgroup analyses highlighted that the intervention was effective when CBT was combined with other therapeutic components which delivered via a mobile application. Preferable features of intervention should be more than eight sessions and conducted for than 6 weeks among postnatal women. Multivariable meta-regression showed that age was a significant covariate on depression symptoms. The sample size in the selected RCTs was small, and the overall quality of the evidence was very low. Digital CBT is a potential intervention for alleviating psychological outcomes in perinatal women. This review suggests the essential features to optimize the intervention effect. Further well-designed RCTs with large sample sizes are necessary.
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Affiliation(s)
- Ying Lau
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Kai Yoong Yen
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Sai Ho Wong
- Alexandra Hospital, National University Health System, Singapore.
| | - Jing Ying Cheng
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Ling Jie Cheng
- Health Systems and Behavioural Sciences Domain, Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
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Werchan DM, Hendrix CL, Ablow JC, Amstadter AB, Austin AC, Babineau V, Anne Bogat G, Cioffredi LA, Conradt E, Crowell SE, Dumitriu D, Fifer W, Firestein MR, Gao W, Gotlib IH, Graham AM, Gregory KD, Gustafsson HC, Havens KL, Howell BR, Humphreys KL, King LS, Kinser PA, Krans EE, Lenniger C, Levendosky AA, Lonstein JS, Marcus R, Monk C, Moyer S, Muzik M, Nuttall AK, Potter AS, Salisbury A, Shuffrey LC, Smith BA, Smith L, Sullivan EL, Zhou J, Thomason ME, Brito NH. Behavioral coping phenotypes and associated psychosocial outcomes of pregnant and postpartum women during the COVID-19 pandemic. Sci Rep 2022; 12:1209. [PMID: 35075202 PMCID: PMC8786860 DOI: 10.1038/s41598-022-05299-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 12/16/2021] [Indexed: 11/09/2022] Open
Abstract
The impact of COVID-19-related stress on perinatal women is of heightened public health concern given the established intergenerational impact of maternal stress-exposure on infants and fetuses. There is urgent need to characterize the coping styles associated with adverse psychosocial outcomes in perinatal women during the COVID-19 pandemic to help mitigate the potential for lasting sequelae on both mothers and infants. This study uses a data-driven approach to identify the patterns of behavioral coping strategies that associate with maternal psychosocial distress during the COVID-19 pandemic in a large multicenter sample of pregnant women (N = 2876) and postpartum women (N = 1536). Data was collected from 9 states across the United States from March to October 2020. Women reported behaviors they were engaging in to manage pandemic-related stress, symptoms of depression, anxiety and global psychological distress, as well as changes in energy levels, sleep quality and stress levels. Using latent profile analysis, we identified four behavioral phenotypes of coping strategies. Critically, phenotypes with high levels of passive coping strategies (increased screen time, social media, and intake of comfort foods) were associated with elevated symptoms of depression, anxiety, and global psychological distress, as well as worsening stress and energy levels, relative to other coping phenotypes. In contrast, phenotypes with high levels of active coping strategies (social support, and self-care) were associated with greater resiliency relative to other phenotypes. The identification of these widespread coping phenotypes reveals novel behavioral patterns associated with risk and resiliency to pandemic-related stress in perinatal women. These findings may contribute to early identification of women at risk for poor long-term outcomes and indicate malleable targets for interventions aimed at mitigating lasting sequelae on women and children during the COVID-19 pandemic.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Dani Dumitriu
- Columbia University Irving Medical Center, New York, USA
| | - William Fifer
- Columbia University Irving Medical Center, New York, USA
| | | | - Wei Gao
- Cedars-Sinai Medical Center, Los Angeles, USA
| | | | | | | | | | | | - Brittany R Howell
- Department of Human Development and Family Science, Fralin Biomedical Research Institute at Virginia Tech Carilion, Virginia Tech, Blacksburg, USA
| | | | | | | | | | | | | | | | | | - Catherine Monk
- Columbia University Irving Medical Center, New York, USA
| | - Sara Moyer
- Virginia Commonwealth University, Richmond, USA
| | | | | | | | | | | | - Beth A Smith
- University of Southern California, Los Angeles, USA
| | - Lynne Smith
- The Lundquist Institute at Harbor-UCLA, West Carson, USA
| | | | - Judy Zhou
- University of Southern California, Los Angeles, USA
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Pontoppidan M, Nygaard L, Thorsager M, Friis-Hansen M, Davis D, Nohr EA. The FACAM study: protocol for a randomized controlled study of an early interdisciplinary intervention to support women in vulnerable positions through pregnancy and the first 5 years of motherhood. Trials 2022; 23:73. [PMID: 35073975 PMCID: PMC8785506 DOI: 10.1186/s13063-022-06022-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 01/12/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Inequality in health can have profound short- and long-term effects on a child's life. Infants develop in a responsive environment, and the relationship between mother and infant begins to develop during pregnancy. The mother's ability to bond with the fetus and newborn child may be challenged by mental health issues which can cause impaired functioning and poorer health outcomes. Families with complex problems need interdisciplinary interventions starting in early pregnancy to be prepared for motherhood and to ensure healthy child development. This study aims to examine the effects of an early and coordinated intervention (the Family Clinic and Municipality (FACAM) intervention) offered to vulnerable pregnant women during pregnancy and the child's first year of life on the mother-child relationship, maternal social functioning, mental health, reflective functioning, well-being, parental stress, and the development and well-being of the child. METHODS The study is a prospective randomized controlled trial where we will randomize 320 pregnant women enrolled to receive antenatal care at the family clinic at Odense University Hospital, to either FACAM intervention or usual care. The FACAM intervention consists of extra support by a health nurse or family therapist during pregnancy and until the child starts school. The intervention is most intensive in the first 12 months and also includes attachment-based support provided either individually or in groups. The participants are assessed at baseline, and when the infant is 3 and 12 months old. The primary outcome is maternal sensitivity measured by the Coding Interactive Behavior (CIB) instrument. Secondary outcomes include prenatal parental reflective functioning, mental well-being, depressive symptoms, breastfeeding duration, maternal satisfaction, child development, parent competence, parental stress, and activities with the child. DISCUSSION The trial is expected to contribute knowledge about the effect of early coordinated support in antenatal and postnatal care for vulnerable pregnant women and their families. TRIAL REGISTRATION ClinicalTrials.gov NCT03659721 . Registered on September 6, 2018.
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Affiliation(s)
- Maiken Pontoppidan
- VIVE - The Danish Centre for Social Science Research, Herluf Trolles Gade 11, 1052, Copenhagen, Denmark.
| | - Lene Nygaard
- University of Canberra and ACT Health, Bruce, Australia
- Research Unit for Gynecology and Obstetrics, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Mette Thorsager
- VIVE - The Danish Centre for Social Science Research, Herluf Trolles Gade 11, 1052, Copenhagen, Denmark
| | - Mette Friis-Hansen
- VIVE - The Danish Centre for Social Science Research, Herluf Trolles Gade 11, 1052, Copenhagen, Denmark
| | - Deborah Davis
- University of Canberra and ACT Health, Bruce, Australia
| | - Ellen Aagaard Nohr
- Research Unit for Gynecology and Obstetrics, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Gynaecology and Obstetrics, Odense University Hospital, Odense, Denmark
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Markey K, Noonan M, Doody O, Tuohy T, Daly T, Regan C, O’Donnell C. Fostering Collective Approaches in Supporting Perinatal Mental Healthcare Access for Migrant Women: A Participatory Health Research Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031124. [PMID: 35162147 PMCID: PMC8834132 DOI: 10.3390/ijerph19031124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/07/2022] [Accepted: 01/13/2022] [Indexed: 11/16/2022]
Abstract
Perinatal mental health is a growing public health concern. The mounting evidence examining the prevalence of perinatal mental illness identifies specific vulnerabilities and risk factors among migrant women. We know that migrant women experience persistent and systematic barriers in accessing healthcare and that healthcare services do not always respond appropriately to migrant women's needs, highlighting the need for targeted interventions in supporting positive perinatal mental health among migrant women. The purpose of this participatory health research study was to explore perinatal mental healthcare for migrant women in Ireland, from the perspectives of a diverse range of stakeholders (healthcare service providers, community organisations/networks/associations and migrant women). A key focus of this study was to collaboratively explore solution-focused approaches to improving access to supports and healthcare services for migrant women experiencing perinatal mental illness. Following ethical approval, data were collected during three key convenings, utilising the design principles of world café philosophies. Thematic analysis led to the generation of the following two themes: Building Capability and Capacity and Empowering Migrant Women. The main conclusions lie in the provision of whole-system approaches in collectively, collaboratively and proactively planning strategies that address the many factors that affect access to healthcare services for migrant women experiencing perinatal mental illness. Drawing on the collective perspectives of a wide range of stakeholders, our innovative solution focused on providing recommendations aimed at strengthening supports and healthcare services for migrant women.
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Affiliation(s)
- Kathleen Markey
- Department of Nursing and Midwifery, Faculty of Education and Health Sciences, Health Research Institute, University of Limerick, V94 T9PX Limerick, Ireland; (M.N.); (O.D.); (T.T.); (C.O.)
- Correspondence:
| | - Maria Noonan
- Department of Nursing and Midwifery, Faculty of Education and Health Sciences, Health Research Institute, University of Limerick, V94 T9PX Limerick, Ireland; (M.N.); (O.D.); (T.T.); (C.O.)
| | - Owen Doody
- Department of Nursing and Midwifery, Faculty of Education and Health Sciences, Health Research Institute, University of Limerick, V94 T9PX Limerick, Ireland; (M.N.); (O.D.); (T.T.); (C.O.)
| | - Teresa Tuohy
- Department of Nursing and Midwifery, Faculty of Education and Health Sciences, Health Research Institute, University of Limerick, V94 T9PX Limerick, Ireland; (M.N.); (O.D.); (T.T.); (C.O.)
| | - Tony Daly
- 80:20 Educating and Acting for a Better World, St. Cronan’s National School, A98 NW42 Wicklow, Ireland; (T.D.); (C.R.)
| | - Ciara Regan
- 80:20 Educating and Acting for a Better World, St. Cronan’s National School, A98 NW42 Wicklow, Ireland; (T.D.); (C.R.)
| | - Claire O’Donnell
- Department of Nursing and Midwifery, Faculty of Education and Health Sciences, Health Research Institute, University of Limerick, V94 T9PX Limerick, Ireland; (M.N.); (O.D.); (T.T.); (C.O.)
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Spadaro B, Martin-Key NA, Funnell E, Bahn S. mHealth Solutions for Perinatal Mental Health: Scoping Review and Appraisal Following the mHealth Index and Navigation Database Framework. JMIR Mhealth Uhealth 2022; 10:e30724. [PMID: 35037894 PMCID: PMC8804959 DOI: 10.2196/30724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 09/06/2021] [Accepted: 11/19/2021] [Indexed: 11/18/2022] Open
Abstract
Background The ever-increasing pressure on health care systems has resulted in the underrecognition of perinatal mental disorders. Digital mental health tools such as apps could provide an option for accessible perinatal mental health screening and assessment. However, there is a lack of information regarding the availability and features of perinatal app options. Objective This study aims to evaluate the current state of diagnostic and screening apps for perinatal mental health available on the Google Play Store (Android) and Apple App Store (iOS) and to review their features following the mHealth Index and Navigation Database framework. Methods Following a scoping review approach, the Apple App Store and Google Play Store were systematically searched to identify perinatal mental health assessment apps. A total of 14 apps that met the inclusion criteria were downloaded and reviewed in a standardized manner using the mHealth Index and Navigation Database framework. The framework comprised 107 questions, allowing for a comprehensive assessment of app origin, functionality, engagement features, security, and clinical use. Results Most apps were developed by for-profit companies (n=10), followed by private individuals (n=2) and trusted health care companies (n=2). Out of the 14 apps, 3 were available only on Android devices, 4 were available only on iOS devices, and 7 were available on both platforms. Approximately one-third of the apps (n=5) had been updated within the last 180 days. A total of 12 apps offered the Edinburgh Postnatal Depression Scale in its original version or in rephrased versions. Engagement, input, and output features included reminder notifications, connections to therapists, and free writing features. A total of 6 apps offered psychoeducational information and references. Privacy policies were available for 11 of the 14 apps, with a median Flesch-Kincaid reading grade level of 12.3. One app claimed to be compliant with the Health Insurance Portability and Accountability Act standards and 2 apps claimed to be compliant with General Data Protection Regulation. Of the apps that could be accessed in full (n=10), all appeared to fulfill the claims stated in their description. Only 1 app referenced a relevant peer-reviewed study. All the apps provided a warning for use, highlighting that the mental health assessment result should not be interpreted as a diagnosis or as a substitute for medical care. Only 3 apps allowed users to export or email their mental health test results. Conclusions These results indicate that there are opportunities to improve perinatal mental health assessment apps. To this end, we recommend focusing on the development and validation of more comprehensive assessment tools, ensuring data protection and safety features are adequate for the intended app use, and improving data sharing features between users and health care professionals for timely support.
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Affiliation(s)
- Benedetta Spadaro
- Cambridge Centre for Neuropsychiatric Research, Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, United Kingdom
| | - Nayra A Martin-Key
- Cambridge Centre for Neuropsychiatric Research, Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, United Kingdom
| | - Erin Funnell
- Cambridge Centre for Neuropsychiatric Research, Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, United Kingdom
| | - Sabine Bahn
- Cambridge Centre for Neuropsychiatric Research, Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, United Kingdom
- Psyomics Ltd, Cambridge, United Kingdom
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Trends in the incidence and DALYs of anxiety disorders at the global, regional, and national levels: Estimates from the Global Burden of Disease Study 2019. J Affect Disord 2022; 297:83-93. [PMID: 34678404 DOI: 10.1016/j.jad.2021.10.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 10/14/2021] [Accepted: 10/18/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Anxiety disorders are the second leading mental health-related cause of disability-adjusted life-years (DALYs) and years lived with disability (YLDs) worldwide. This study aimed to quantitatively assess the burden of anxiety disorders at the global, regional, and national levels in 1990 and 2019 and the trends over this period. METHODS We used data for incidence cases, DALYs, age-standardized incidence rate (ASIR) and age-standardized DALYs rate (ASDR) from Global Burden of Disease Study 2019 (GBD 2019) and calculated the estimated annual percentage changes (EAPCs) to assess the incidence rate and DALYs rate trends for anxiety disorders. RESULTS The incidence cases of anxiety disorders increased by 47.19%, from 31.13 million in 1990 to 45.82 million in 2019, and DALYs increased by 53.70%, from 18.66 million in 1990 to 28.68 million in 2019. Over the past 29 years, the changes of ASIR and ASDR worldwide were stable (EAPC = 0.011 and -0.001, respectively). Women were more likely to experience anxiety disorders. Participants aged 10-14 had the highest incidence rate, followed by those aged 35-44. Those aged 15-19 and 40-44 had the highest estimated DALYs rate. The ASIR and ASDR were estimated to be the highest in Iran and Portugal, and Portugal and Brazil, respectively. Both of ASIR and ASDR were high in high- sociodemographic index regions in 2019. LIMITATIONS Further exploration of related risk factors needs to be analyzed in the future studies. CONCLUSIONS Compared with 1990, the absolute increase in incidence cases and DALYs of anxiety disorders in 2019 still remained high. Our findings contribute to the formulation of health policies for controlling and preventing anxiety disorders in different countries and regions.
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Alfayumi-Zeadna S, Bina R, Levy D, Merzbach R, Zeadna A. Elevated Perinatal Depression during the COVID-19 Pandemic: A National Study among Jewish and Arab Women in Israel. J Clin Med 2022; 11:jcm11020349. [PMID: 35054043 PMCID: PMC8778708 DOI: 10.3390/jcm11020349] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 01/07/2022] [Accepted: 01/10/2022] [Indexed: 12/10/2022] Open
Abstract
This study assessed prevalence of perinatal depression symptoms (PNDS) during the COVID-19 pandemic among Arab and Jewish women in Israel and identified COVID-19-related risk factors for PNDS, while comparing Arab and Jewish women. Sample included 730 perinatal women (604 Jewish and 126 Arab) aged 19-45 years, who filled out an online self-report questionnaire. The questionnaire assessed several areas: perinatal experiences and exposure to COVID-19, social support, and financial and emotional impact. PNDS was measured by the Edinburgh Postnatal Depression Scale (EPDS). Prevalence of PNDS (EPDS ≥ 10) in the entire study population was 40.0%. Prevalence among Arab women was significantly higher compared to Jewish women (58% vs. 36%, PV < 0.001). Higher PNDS were significantly associated with anxiety symptoms (GAD ≥ 10) (PV < 0.001), stress related to COVID-19 (PV < 0.001), adverse change in delivery of healthcare services (PV = 0.025), and unemployment (PV = 0.002). PNDS has elevated more than twofold during COVID-19 in Israel. Such high rates of PNDS may potentially negatively impact women, and fetal and child health development. This situation requires special attention from public health services and policy makers to provide support and mitigation strategies for pregnant and postpartum women in times of health crises.
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Affiliation(s)
- Samira Alfayumi-Zeadna
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Michael’s Hospital, Unity Health Toronto, Toronto, ON M5B 1W8, Canada
- Correspondence:
| | - Rena Bina
- The Louis and Gabi Weisfeld School of Social Work, Bar Ilan University, Ramat Gan 5290002, Israel; (R.B.); (D.L.); (R.M.)
| | - Drorit Levy
- The Louis and Gabi Weisfeld School of Social Work, Bar Ilan University, Ramat Gan 5290002, Israel; (R.B.); (D.L.); (R.M.)
| | - Rachel Merzbach
- The Louis and Gabi Weisfeld School of Social Work, Bar Ilan University, Ramat Gan 5290002, Israel; (R.B.); (D.L.); (R.M.)
| | - Atif Zeadna
- Fertility and IVF Unit, Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 8410402, Israel;
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Hicks LM, Ou C, Charlebois J, Tarasoff L, Pawluski J, Roos LE, Hooykaas A, Fairbrother N, Carter M, Tomfohr-Madsen L. Assessment of Canadian perinatal mental health services from the provider perspective: Where can we improve? Front Psychiatry 2022; 13:929496. [PMID: 36213903 PMCID: PMC9537741 DOI: 10.3389/fpsyt.2022.929496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 09/05/2022] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Perinatal mental health disorders are common, and rates have increased during the COVID-19 pandemic. It is unclear where providers may improve perinatal mental health care, particularly in countries lacking national guidelines, such as Canada. METHODS A cross-sectional survey of perinatal health providers was conducted to describe the landscape of perinatal mental health knowledge, screening, and treatment practices across Canada. Providers were recruited through listservs, social media, and snowball sampling. Participants completed an online survey that assessed their perinatal mental health training, service provision types, their patient wait times, and treatment barriers, and COVID-19 pandemic-related impacts. RESULTS A total of 435 providers completed the survey, including physicians, midwives, psychologists, social workers, nurses, and allied non-mental health professionals. Most (87.0%) did not have workplace mandated screening for perinatal mental illness but a third (66%) use a validated screening tool. Many (42%) providers stated their patients needed to wait more than 2 months for services. More than half (57.3%) reported they did not receive or were unsure if they received specialized training in perinatal mental health. Most (87.0%) indicated there were cultural, linguistic, and financial barriers to accessing services. Over two-thirds (69.0%) reported the COVID-19 pandemic reduced access to services. CONCLUSION Survey findings reveal significant gaps in training, screening tool use, and timely and culturally safe treatment of perinatal mental health concerns. There is critical need for coordinated and nationally mandated perinatal mental health services in Canada to improve care for pregnant and postpartum people.
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Affiliation(s)
- Laurel M Hicks
- Renée Crown Wellness Institute, University of Colorado Boulder, Boulder, CO, United States
| | - Christine Ou
- School of Nursing, University of Victoria, Victoria, BC, Canada
| | | | - Lesley Tarasoff
- Department of Health and Society, University of Toronto Scarborough, Toronto, ON, Canada
| | - Jodi Pawluski
- IRSET - Institut de Recherche en Santé, Environnement et Travail, University of Rennes 1, Rennes, France
| | - Leslie E Roos
- Department of Psychology, University of Manitoba, Winnipeg, MB, Canada
| | - Amanda Hooykaas
- College of Social and Applied Social Sciences, University of Guelph, Guelph, ON, Canada
| | | | - Michelle Carter
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
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174
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Malouf R, Harrison S, Burton HA, Gale C, Stein A, Franck LS, Alderdice F. Prevalence of anxiety and post-traumatic stress (PTS) among the parents of babies admitted to neonatal units: A systematic review and meta-analysis. EClinicalMedicine 2022; 43:101233. [PMID: 34993425 PMCID: PMC8713115 DOI: 10.1016/j.eclinm.2021.101233] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 11/09/2021] [Accepted: 11/26/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Parents of babies admitted to neonatal units (NNU) are exposed to a range of potentially distressing experiences, which can lead to mental health symptoms such as increased anxiety and post-traumatic stress (PTS). This review aimed to describe how anxiety and PTS are defined and assessed, and to estimate anxiety and PTS prevalence among parents of babies admitted to NNU. METHOD Medline, Embase, PsychoINFO, Cumulative Index to Nursing and Allied Health literature were searched to identify studies published prior to April 14, 2021. Included studies were assessed using Hoy risk of bias tool. A random-effects model was used to estimate pooled prevalence with 95% CIs. Potential sources of variation were investigated using subgroup analyses and meta-regression. The review is registered with PROSPERO (CRD42020162935). FINDINGS Fifty six studies involving 6,036 parents met the review criteria; 21 studies assessed anxiety, 35 assessed PTS, and 8 assessed both. The pooled prevalence of anxiety was 41.9% (95%CI:30.9, 53.0) and the pooled prevalence of PTS was 39.9% (95%CI:30.8, 48.9) among parents up to one month after the birth. Anxiety prevalence decreased to 26.3% (95%CI:10.1, 42.5) and PTS prevalence to 24.5% (95%CI:17.4, 31.6) between one month and one year after birth. More than one year after birth PTS prevalence remained high 27.1% (95%CI:20.7, 33.6). Data on anxiety at this time point were limited. There was high heterogeneity between studies and some evidence from subgroup and meta-regression analyses that study characteristics contributed to the variation in prevalence estimates. INTERPRETATION The prevalence of anxiety and PTS was high among parents of babies admitted to NNU. The rates declined over time, although they remained higher than population prevalence estimates for women in the perinatal period. Implementing routine screening would enable early diagnosis and effective intervention. FUNDING This research is funded by the National Institute for Health Research (NIHR) Policy Research Programme, conducted through the Policy Research Unit in Maternal and Neonatal Health and Care, PR-PRU-1217-21202. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.
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Affiliation(s)
- Reem Malouf
- Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
| | - Sian Harrison
- Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
| | - Hollie A.L Burton
- Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
| | - Chris Gale
- Neonatal Medicine, School of Public Health, Faculty of Medicine, Imperial College London, Chelsea and Westminster campus, 369 Fulham Road, London, SW10 9NH
| | - Alan Stein
- Department of Psychiatry, Medical Sciences Division, University of Oxford, Oxford, UK
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa Honorary Professor, African Health Research Institute, KwaZulu, Natal
| | - Linda S. Franck
- Department of Family Health Care Nursing, School of Nursing, University of California San Francisco, 2 Koret Way, San Francisco, CA 94143, USA
| | - Fiona Alderdice
- Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
- School of Nursing and Midwifery, Queens University Belfast, Belfast, UK
- Corresponding author:-Fiona Alderdice, Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford OX3 7LF
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175
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Reynolds KA, Pankratz L, Cameron EE, Roos LE, Giesbrecht GF, Lebel C, Tomfohr-Madsen LM. Pregnancy during the COVID-19 pandemic: a qualitative examination of ways of coping. Arch Womens Ment Health 2022; 25:1137-1148. [PMID: 36443483 PMCID: PMC9707189 DOI: 10.1007/s00737-022-01277-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 11/07/2022] [Indexed: 11/30/2022]
Abstract
The COVID-19 pandemic and related public health restrictions have impacted the mental health and coping strategies of many population groups, including people who are pregnant. Our study sought to explore the ways that pregnant people described coping with stressors associated with the pandemic. N = 5879 pregnant individuals completed the pan-Canadian Pregnancy During the COVID-19 Pandemic Survey between April and December 2020. We used descriptive statistics to quantify sociodemographic characteristics and thematic analysis (Braun & Clarke, 2006, 2019) to analyze n = 3316 open-ended text responses to the question "Can you tell us what things you are doing to cope with the COVID-19 pandemic?" The average age of participants was 32 years (SD = 4.4), with the majority identifying as White (83.6%), female (99.7%), married (61.5%), having completed post-secondary education (90.0%), and working full-time (75.4%). We categorized participant responses into two overarching thematic dimensions: (1) ways of coping and (2) coping challenges. Ways of coping included the following main themes: (1) taking care of oneself, (2) connecting socially, (3) engaging in pandemic-specific coping strategies, (4) keeping busy, (5) taking care of others, (6) creating a sense of normalcy, (7) changing perspectives, and (8) practicing spirituality. Coping challenges included the following: (1) the perception of coping poorly, (2) loss of coping methods, (3) managing frontline or essential work, and (4) worries about the future. Findings highlight important implications for targeted prenatal supports delivered remotely, including opportunities for social support, prenatal care, and mental health strategies.
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Affiliation(s)
- Kristin A. Reynolds
- Department of Psychology, University of Manitoba, Winnipeg, Manitoba Canada ,Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba Canada
| | - Lily Pankratz
- Department of Psychology, University of Manitoba, Winnipeg, Manitoba Canada
| | - Emily E. Cameron
- Department of Psychology, University of Manitoba, Winnipeg, Manitoba Canada
| | - Leslie E. Roos
- Department of Psychology, University of Manitoba, Winnipeg, Manitoba Canada
| | - Gerald F. Giesbrecht
- Departments of Pediatrics and Community Health Sciences, University of Calgary, Calgary, Alberta Canada
| | - Catherine Lebel
- Department of Radiology, University of Calgary, Calgary, Alberta Canada
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176
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Mahaffey BL, Levinson A, Preis H, Lobel M. Elevated risk for obsessive-compulsive symptoms in women pregnant during the COVID-19 pandemic. Arch Womens Ment Health 2022; 25:367-376. [PMID: 34269873 PMCID: PMC8282770 DOI: 10.1007/s00737-021-01157-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 06/14/2021] [Indexed: 12/17/2022]
Abstract
The COVID-19 pandemic has led to a public mental health crisis with many people experiencing new or worsening anxiety. Fear of contagion and the lack of predictability/control in daily life increased the risk for problems such as obsessive-compulsive disorder (OCD) in the general population. Pregnant women may be particularly vulnerable to such pandemic-related stressors yet the prevalence of OC symptoms in this population during the pandemic remains unknown. We examined the prevalence of OC symptoms in a sample of 4451 pregnant women in the USA, recruited via targeted online methods at the start of the pandemic. Participants completed self-report measures including the Obsessive-Compulsive Inventory-Revised and the Pandemic-Related Pregnancy Stress Scale. Clinically significant OC symptoms were present in 7.12% of participants, more than twice as high as rates of peripartum OCD reported prior to the pandemic. Younger maternal age, income loss, and suspected SARS-CoV-2 infection were all associated with higher OC symptoms. Two types of pregnancy-specific stress, pandemic-related and pandemic-unrelated, were both associated with higher levels of OC symptoms. Pandemic-related pregnancy stress predicted OC symptoms even after controlling for non-pandemic-related, pregnancy-specific stress. Elevated rates of OC symptoms were observed in women pregnant during the pandemic, particularly those experiencing elevated pandemic-related pregnancy stress. This type of stress confers a distinct risk for OC symptoms above and beyond pregnancy-specific stress and demographic factors. Healthcare providers should be prepared to see and treat more peripartum women with OC symptoms during this and future public health crises.
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Affiliation(s)
- Brittain L. Mahaffey
- Department of Psychiatry and Behavioral Health, Renaissance School of Medicine, Stony Brook University, Putnam Hall, New York, NY 11794 USA
| | - Amanda Levinson
- Department of Psychiatry and Behavioral Health, Renaissance School of Medicine, Stony Brook University, Putnam Hall, New York, NY 11794 USA ,Department of Psychology, Stony Brook University, New York, NY 11794 USA
| | - Heidi Preis
- Department of Psychology, Stony Brook University, New York, NY 11794 USA ,Department of Pediatrics, Renaissance School of Medicine, Stony Brook University, New York, NY 11794 USA
| | - Marci Lobel
- Department of Psychology, Stony Brook University, New York, NY 11794 USA
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177
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Green SM, Inness B, Furtado M, McCabe RE, Frey BN. Evaluation of an Augmented Cognitive Behavioural Group Therapy for Perinatal Generalized Anxiety Disorder (GAD) during the COVID-19 Pandemic. J Clin Med 2021; 11:jcm11010209. [PMID: 35011950 PMCID: PMC8745906 DOI: 10.3390/jcm11010209] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 12/19/2021] [Accepted: 12/29/2021] [Indexed: 12/22/2022] Open
Abstract
The perinatal period is considered a window of vulnerability given the increased risk of psychiatric difficulties during this time, such as mood and anxiety disorders (ADs). Pre-pandemic rates of ADs in perinatal women were one in five but have since increased with the onset of the COVID-19 pandemic (COVID). In addition, recent research suggests that the focus of worry has shifted during the pandemic, with perinatal women reporting significantly more COVID-specific worries. The objective of this study was to augment our current evidence-based Cognitive Behavioural Group Therapy (CBGT) for perinatal anxiety protocol by targeting intolerance of uncertainty and tailoring existing strategies to address COVID-related worry and impact. Pregnant (n = 19) and postpartum (n = 49) women were recruited from regular clinic patient flow from a university-affiliated teaching hospital between September 2020 and March 2021. Improvements in generalized anxiety symptoms, worry, intolerance of uncertainty, and mood were observed at post-treatment, maintained at 3-months, and the intervention received high ratings of treatment satisfaction. This is the first study to examine an augmented CBGT for perinatal women with GAD during the pandemic and supports the inclusion of strategies that target intolerance of uncertainty as well as specific pandemic and perinatal worry content for effective outcomes.
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Affiliation(s)
- Sheryl M. Green
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON L8N 3K7, Canada; (R.E.M.); (B.N.F.)
- Women’s Health Concerns Clinic, St. Joseph’s Healthcare, Hamilton, ON L8N 3K7, Canada; (B.I.); (M.F.)
- Correspondence: ; Tel.: +1-905-522-1155 (ext. 33672)
| | - Briar Inness
- Women’s Health Concerns Clinic, St. Joseph’s Healthcare, Hamilton, ON L8N 3K7, Canada; (B.I.); (M.F.)
- Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, ON L8N 3K7, Canada
| | - Melissa Furtado
- Women’s Health Concerns Clinic, St. Joseph’s Healthcare, Hamilton, ON L8N 3K7, Canada; (B.I.); (M.F.)
- Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, ON L8N 3K7, Canada
| | - Randi E. McCabe
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON L8N 3K7, Canada; (R.E.M.); (B.N.F.)
- Anxiety Treatment and Research Clinic, St. Joseph’s Healthcare, Hamilton, ON L8N 3K7, Canada
| | - Benicio N. Frey
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON L8N 3K7, Canada; (R.E.M.); (B.N.F.)
- Women’s Health Concerns Clinic, St. Joseph’s Healthcare, Hamilton, ON L8N 3K7, Canada; (B.I.); (M.F.)
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178
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Fairbrother N, Albert A, Keeney C, Tchir D, Cameron RB. Screening for Perinatal OCD: A Comparison of the DOCS and the EPDS. Assessment 2021; 30:1028-1039. [PMID: 34969305 PMCID: PMC10152558 DOI: 10.1177/10731911211063223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Screening for perinatal-occurring obsessive-compulsive disorder (OCD) is rare. We sought to evaluate the Dimensional Obsessive-Compulsive Scale (DOCS) as a screening tool for perinatal OCD and compare the screening accuracy of the DOCS with the commonly recommended Edinburgh Postnatal Depression Scale (EPDS). English-speaking, pregnant individuals aged 19+ (N = 574) completed online questionnaires and diagnostic interviews to assess for OCD prenatally and twice postpartum. The DOCS total score demonstrated the highest level of accuracy. Neither the EPDS-Full nor the three-item Anxiety subscale of the EPDS (EPDS-3A) met the criteria of a sufficiently accurate screening tool for OCD at any of the assessment points. Findings provide support for the DOCS as a screening tool for perinatal OCD and indicate a need for disorder-specific screening for perinatal anxiety and their related disorders (AD). Generalizability of findings is limited to Canada only. Future research would benefit from comparisons with measures of perinatal OCD (e.g., the Perinatal Obsessive-Compulsive Scale).
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Affiliation(s)
| | - Arianne Albert
- Women's Health Research Institute, Vancouver, British Columbia, Canada
| | - Cora Keeney
- The University of British Columbia, Vancouver, British Columbia, Canada
| | - Devan Tchir
- The University of British Columbia, Vancouver, British Columbia, Canada
| | - Rose B Cameron
- The University of British Columbia, Vancouver, British Columbia, Canada
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179
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Furtado M, Frey BN, Green SM. Validation of the intolerance of uncertainty scale as a screening tool for perinatal anxiety. BMC Pregnancy Childbirth 2021; 21:829. [PMID: 34903196 PMCID: PMC8670292 DOI: 10.1186/s12884-021-04296-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 11/24/2021] [Indexed: 11/11/2022] Open
Abstract
Background To date, there is a significant lack of research validating clinical tools for early and accurate detection of anxiety disorders in perinatal populations. Intolerance of uncertainty was recently identified as a significant risk factor for postpartum anxiety symptoms and is a key trait of non-perinatal anxiety disorders. The present study aimed to validate the Intolerance of Uncertainty Scale (IUS) in a perinatal population and evaluate its use as a screening tool for anxiety disorders. Methods Psychiatric diagnoses were assessed in a sample of perinatal women (n = 198), in addition to completing a self-report battery of questionnaires. Psychometric properties including internal consistency and convergent and discriminant validity were assessed. Determination of an optimal clinical cut-off score was measured through a ROC analysis in which the area under the curve, sensitivity, specificity, as well as positive and negative predictive values were calculated. Results The IUS demonstrated excellent internal consistency (α = 0.95) and an optimal clinical cut-off score of 64 or greater was established, yielding a sensitivity of 89%. The IUS also demonstrated very good positive (79%) and negative (80%) predictive values. Conclusions These findings suggest that the IUS represents a clinically useful screening tool to be used as an aid for the early and accurate detection of perinatal anxiety.
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Affiliation(s)
- Melissa Furtado
- Department of Psychology, Neuroscience and Behaviour, McMaster University, 1280 Main Street West, Ontario, Hamilton, L8S 4L8, Canada. .,Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Level 1, 100 West 5th Street, Hamilton, Ontario, L8N 3K7, Canada.
| | - Benicio N Frey
- Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Level 1, 100 West 5th Street, Hamilton, Ontario, L8N 3K7, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Administration B3, 100 West 5th Street, Hamilton, Ontario, L8N 3K7, Canada.,Mood Disorders Program, St. Joseph's Healthcare Hamilton, Level 1, 100 West 5th Street, Hamilton, Ontario, L8N 3K7, Canada
| | - Sheryl M Green
- Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Level 1, 100 West 5th Street, Hamilton, Ontario, L8N 3K7, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Administration B3, 100 West 5th Street, Hamilton, Ontario, L8N 3K7, Canada
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180
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Garcia K, Mancuso A, Le HN. Mothers' experiences of perinatal obsessive-compulsive disorder. J Reprod Infant Psychol 2021:1-11. [PMID: 34894885 DOI: 10.1080/02646838.2021.2013457] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Perinatal obsessive-compulsive disorder (POCD) is characterised by the presence of intrusive thoughts resulting in significant distress and urges to execute repeated behaviours occurring in the perinatal period. POCD is largely understudied and existing literature has mostly studied POCD quantitatively. OBJECTIVE This qualitative study explores the experiences of 10 mothers randomly selected from a larger sample (N = 251; 86.8% White) who met high risk criteria based on the Postnatal Obsessive-Compulsive Scale (POCS≥16). These mothers were interviewed about their experiences with POCD retrospectively. RESULTS Qualitative analysis of the interviews (n = 10) revealed three main themes regarding women's experiences with POCD: 1) obsessions (i.e. safety, cleanliness), 2) compulsions (i.e. excessive checking for safety, excessive cleaning, researching information online), and 3) other emotional experiences (i.e. fear, panic, anxiety, suicidal ideation, guilt, shame, irritability/anger). CONCLUSION Mothers at high risk for POCD report obsessions and compulsions as well as other emotional experiences that are distressing, demonstrating the enduring impact of POCD beyond the perinatal period.
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Affiliation(s)
- Klarissa Garcia
- Department of Psychological and Brain Sciences, George Washington University, Washington, DC, USA
| | - Alyssa Mancuso
- Department of Psychological and Brain Sciences, George Washington University, Washington, DC, USA
| | - Huynh-Nhu Le
- Department of Psychological and Brain Sciences, George Washington University, Washington, DC, USA
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181
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Barger MK. Current Resources for Evidence-Based Practice, November/December 2021. J Midwifery Womens Health 2021; 66:806-812. [PMID: 34883545 DOI: 10.1111/jmwh.13318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 11/01/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Mary K Barger
- Hahn School of Nursing and Health Science, Beyster Institute for Nursing Research, University of San Diego, San Diego, California
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182
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Maternal Mental Health following Ultrasonographic Detection of Fetal Structural Anomaly in the Midst of the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182412900. [PMID: 34948508 PMCID: PMC8701233 DOI: 10.3390/ijerph182412900] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 11/29/2021] [Accepted: 12/05/2021] [Indexed: 11/16/2022]
Abstract
Prenatal ultrasonographic detection of fetal structural anomaly may adversely affect maternal mental health throughout pregnancy, particularly in the current COVID-19 pandemic. This study aims to prospectively assess maternal stress, anxiety, and depression following ultrasonographic detection of fetal structural anomaly from diagnosis until delivery during the COVID-19 pandemic. A total of 141 pregnant women at a tertiary hospital who underwent detailed scans between 16 and 24 gestational weeks were included and categorized into the study (anomaly finding, n = 65) and comparison (normal finding, n = 76) groups. Self-administered questionnaires of 10-item Perceived Stress Scale (PSS-10) and Hospital Anxiety and Depression Scale (HADS) were used to assess maternal stress, anxiety, and depression at prior detection (T1), two-to-four weeks post-detection (T2), one-to-two weeks prior to delivery (T3), and one-to-two weeks post-delivery (T4). Repeated measures of analysis of variance (ANOVA) were conducted to assess time-, between-group, and time-group interaction effect. In general, maternal stress improved, but anxiety worsened, while depression persisted, over the time from T1 to T4. The average maternal stress and anxiety levels were significantly higher among groups with fetal anomaly. The maternal stress and anxiety level were significantly affected within one-to-two weeks post-detection of fetal structural anomaly. In conclusion, maternal mental health parameters were affected differently during the COVID-19 pandemic, with higher vulnerability of stress and anxiety among pregnant women with fetal structural anomaly particularly within one-to-two weeks post-detection.
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183
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Maternal Mental Health. MCN Am J Matern Child Nurs 2021; 47:59. [PMID: 34860793 DOI: 10.1097/nmc.0000000000000785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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184
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Furer P, Alcolado G, Reynolds K, Hebert EA. Group cognitive-behavioural therapy for perinatal anxiety disorders: Treatment development, content, and pilot results. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2021. [DOI: 10.1016/j.jadr.2021.100195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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185
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Perspectives on barriers and facilitators to mental health support after a traumatic birth among a sample of primarily White and privately insured patients. Gen Hosp Psychiatry 2021; 73:46-53. [PMID: 34583284 PMCID: PMC8629868 DOI: 10.1016/j.genhosppsych.2021.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 08/23/2021] [Accepted: 08/25/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To elicit the perspectives of individuals with a traumatic birth experience on barriers and facilitators to receiving mental health support in the postpartum period. METHODS Individuals who experienced a traumatic birth within the last three years (n = 32) completed semi-structured phone interviews about their birth and postpartum experience. The Post-traumatic Stress Disorder Checklist for DSM-V (PCL-5), Patient Health Questionnaire (PHQ-8), and Generalized Anxiety Disorder scale (GAD-7) were administered. Qualitative data was analyzed using a modified grounded theory by three independent coders. RESULTS Among participants, 34.4% screened positive for PTSD, 18.8% for depression, and 34.4% for anxiety. Participants described multi-level barriers that prevented clinicians from recognizing and supporting patients' postpartum mental health needs; those involved lack of communication, education, and resources. Recommendations from participants included that 1) obstetric professionals should acknowledge birth-related trauma experienced by any individual, 2) providers of multiple disciplines need to be integrated into postpartum care, and 3) mental health support may be needed before the ambulatory postpartum visit. CONCLUSIONS There are multi-level barriers towards detecting and responding to individuals' mental health needs after a traumatic birth. Obstetric professionals need to use a trauma-informed approach and proactively assess mental health throughout the postpartum period.
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186
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Rosinger ZJ, Mayer HS, Geyfen JI, Orser MK, Stolzenberg DS. Ethologically relevant repeated acute social stress induces maternal neglect in the lactating female mouse. Dev Psychobiol 2021; 63:e22173. [PMID: 34674243 PMCID: PMC10631567 DOI: 10.1002/dev.22173] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 06/23/2021] [Accepted: 06/26/2021] [Indexed: 12/27/2022]
Abstract
Psychosocial stress is a top predictor of peripartum mood disorders in human mothers. In the present study, we developed a novel paradigm testing the effects of direct and vicarious social stress on maternal and mood-related behaviors in B6 mice. Using a novel housing paradigm, we examined the extent to which postpartum dams withdrew from litters following psychosocial stress. Repeated acute direct social stress involved exposing dams to a virgin male mouse for 7 min/day on postpartum days 5-7 during a brief (15-min) mother-pup separation. To remove the effects of direct stress, the vicarious social stress dams were housed in the same vivarium as direct social stressed dams, but without direct exposure to intruders. Control dams were given mock intruder exposure and housed in a separate vivarium room containing breeding mice. All dams experienced pup separation, and maternal care was investigated upon reunion. Direct and vicarious social stress induced significant deficits in maternal care and increased maternal anxiety relative to controls. Although vicarious stress effects were more likely to occur on days when there was acute stress exposure, direct stress sustained maternal deficits 24 h after the final stressor. Together, these data suggest psychosocial stress induces aberrant maternal phenotypes in mice.
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Affiliation(s)
- Zachary J Rosinger
- Department of Psychology, University of California, Davis, California, USA
| | - Heather S Mayer
- Department of Psychology, University of California, Davis, California, USA
| | | | - Mable K Orser
- Department of Psychology, University of California, Davis, California, USA
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Kimmel M, Jin W, Xia K, Lun K, Azcarate-Peril A, Plantinga A, Wu M, Ataei S, Rackers H, Carroll I, Meltzer-Brody S, Fransson E, Knickmeyer R. Metabolite trajectories across the perinatal period and mental health: A preliminary study of tryptophan-related metabolites, bile acids and microbial composition. Behav Brain Res 2021; 418:113635. [PMID: 34755640 DOI: 10.1016/j.bbr.2021.113635] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 09/26/2021] [Accepted: 10/18/2021] [Indexed: 01/06/2023]
Abstract
Depression and anxiety during pregnancy and postpartum are common, but affected women differ in timing, trajectories, and extent of symptoms. The objective of this pilot, feasibility study is to analyze trajectories of serotonin and tryptophan-related metabolites, bile acid metabolites, and microbial composition, in relation to psychiatric history and current symptoms across the perinatal period. Serum and fecal samples were collected from 30 women at three times points in the perinatal period and assayed with LC-MS/MS and 16S sequencing respectively. We defined mean trajectories for each metabolite, clustered individuals by metabolite trajectories, tested associations between metabolites, and examined metabolite levels in relation to microbial composition. Findings of note include: (1) changes in kynurenine and the ratio of kynurenic acid to kynurenine from second trimester to third trimester were strongly associated with baseline primary and secondary bile acids. (2) Secondary bile acid UDCA and its conjugated forms were associated with lower bacterial diversity and levels of Lachnospiraceae, a taxa known to produce Short Chain Fatty Acids. (3) History of anxiety was associated with UDCA levels, but history of major depression was not associated with any of the bile acids. (4) There was a trend towards lower dietary fiber for those with history of anxiety or depression. Overall, our results reveal substantial temporal variation in tryptophan-related metabolites and in bile acid metabolites over the perinatal period, with marked inter-individual variability. Trajectories of TRP -related metabolites, primary and secondary bile acids, and the absence or presence of microbes that produce Short Chain Fatty Acids (SCFAs) considered in concert have the potential to differentiate individuals based on perinatal adaptations that may impact mental and overall health.
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Affiliation(s)
- Mary Kimmel
- University of North Carolina-Chapel Hill Department of Psychiatry, United States; Uppsala University, Department of Women and Children's Health, Sweden.
| | - Wanting Jin
- University of North Carolina-Chapel Hill Department of Psychiatry, United States
| | - Kai Xia
- University of North Carolina-Chapel Hill Department of Psychiatry, United States
| | - Kun Lun
- University of North Carolina-Chapel Hill Gillings School of Public Health, United States
| | - Andrea Azcarate-Peril
- University of North Carolina-Chapel Hill Department of Medicine and UNC Microbiome Core, United States
| | - Anna Plantinga
- Williams College Department of Mathematics and Statistics, United States
| | - Michael Wu
- University of North Carolina-Chapel Hill Department of Psychiatry, United States
| | - Shirin Ataei
- University of North Carolina-Chapel Hill Department of Psychiatry, United States
| | - Hannah Rackers
- University of North Carolina-Chapel Hill Department of Psychiatry, United States
| | - Ian Carroll
- University of North Carolina-Chapel Hill School of Public Health Department of Nutrition, United States
| | | | - Emma Fransson
- Uppsala University, Department of Women and Children's Health, Sweden; Department of Microbiology, Tumor and Cell Biology, Karolinska Insitutet Centre for Translational Microbiome Research, Sweden
| | - Rebecca Knickmeyer
- University of North Carolina-Chapel Hill Department of Psychiatry, United States; Michigan State University Department of Pediatrics and Human Development, United States
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188
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Ilska M, Kołodziej-Zaleska A, Brandt-Salmeri A, Preis H, Lobel M. Pandemic Stress and Its Correlates among Pregnant Women during the Second Wave of COVID-19 in Poland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:11140. [PMID: 34769659 PMCID: PMC8582876 DOI: 10.3390/ijerph182111140] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 10/18/2021] [Accepted: 10/19/2021] [Indexed: 12/26/2022]
Abstract
Background: The ongoing COVID-19 pandemic has created numerous stressful conditions, especially for vulnerable populations such as pregnant women. Pandemic-related pregnancy stress consists of two dimensions: stress associated with feeling unprepared for birth due to the pandemic (Preparedness Stress), and stress related to fears of perinatal COVID-19 infection (Perinatal Infection Stress). The purpose of our study was to elucidate the association between various factors-sociodemographic, obstetric, pandemic-related, and situational-and pandemic stress in its two dimensions during the second wave of the COVID-19 pandemic in Polish pregnant women. Methods: A cross-sectional study with a total of 1119 pregnant women recruited during the second wave of the COVID-19 pandemic in Poland (between November 2020 and January 2021). Participants were recruited via social media to complete an online study questionnaire that included sociodemographic, obstetric, situational, and COVID-19 pandemic factors, as well as the Pandemic-Related Pregnancy Stress Scale (PREPS). Results: Nearly 38.5% of participants reported high Preparedness Stress; 26% reported high Perinatal Infection Stress. Multivariate analyses indicated that lack of COVID-19 diagnosis, higher compliance with safety rules and restrictions, and limited access to outdoor space were independently associated with moderate to severe levels of Infection Stress. Current emotional or psychiatric problems, nulliparity, limited access to outdoor space, and alterations to obstetric visits were independently associated with moderate to severe Preparedness Stress. Conclusion: Study findings suggest that particular attention should be focused on the groups of pregnant women who are most vulnerable to pandemic-related stress and therefore may be more prone to adverse outcomes associated with prenatal stress.
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Affiliation(s)
- Michalina Ilska
- Institute of Psychology, University of Silesia in Katowice, Grażyńskiego Street 53, 40-126 Katowice, Poland; (A.K.-Z.); (A.B.-S.)
| | - Anna Kołodziej-Zaleska
- Institute of Psychology, University of Silesia in Katowice, Grażyńskiego Street 53, 40-126 Katowice, Poland; (A.K.-Z.); (A.B.-S.)
| | - Anna Brandt-Salmeri
- Institute of Psychology, University of Silesia in Katowice, Grażyńskiego Street 53, 40-126 Katowice, Poland; (A.K.-Z.); (A.B.-S.)
| | - Heidi Preis
- Department of Psychology, Stony Brook University, Stony Brook, NY 11794, USA; (H.P.); (M.L.)
| | - Marci Lobel
- Department of Psychology, Stony Brook University, Stony Brook, NY 11794, USA; (H.P.); (M.L.)
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189
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Coo S, García MI, Mira A. Examining the association between subjective childbirth experience and maternal mental health at six months postpartum. J Reprod Infant Psychol 2021:1-14. [PMID: 34672883 DOI: 10.1080/02646838.2021.1990233] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PROBLEM Childbirth experience can have long-lasting effects on maternal wellbeing. BACKGROUND Positive childbirth experiences may strengthen maternal self-confidence, in contrast, negativeexperiences may promote a sense of failure or distrust. AIM To examine the contribution of maternal hospital childbirth experience on mental health at 6 months postpartum in a community-based, Chilean sample. An additional aim is to examine which childbirth-related aspects contribute to the global birth experience. METHODS One hundred and forty-eight women completed self-report measures of mental health during the third trimester of pregnancy and 3 and 6 months postpartum. At 3months after childbirth, subjective childbirth experience was assessed. Logistic regression analysis examined the contribution of childbirth experience to maternal mental health. FINDINGS Negative subjective experience of childbirth contributes to maternal depression and anxiety up to 6 months after childbirth, controlling for mental health during pregnancy and at 3 months postpartum. Quality of care from health professionals made the largest, statistically significant contribution to the global perception of childbirth. DISCUSSION AND CONCLUSIONS Subjective experience of childbirth is a modifiable risk factor for the development of postpartum maternal depression and anxiety. Health providers in direct contact with childbearing women may promote maternal emotional wellbeing through sensitive and respectful care.
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Affiliation(s)
- Soledad Coo
- Facultad De Psicología, Universidad Del Desarrollo (UDD), Santiago, Chile
| | | | - Andrea Mira
- Facultad De Psicología, Universidad Del Desarrollo (UDD), Santiago, Chile
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190
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Callanan F, Tuohy T, Bright AM, Grealish A. The effectiveness of psychological interventions for pregnant women with anxiety in the antenatal period: A systematic review. Midwifery 2021; 104:103169. [PMID: 34749125 DOI: 10.1016/j.midw.2021.103169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 09/17/2021] [Accepted: 10/11/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Anxiety is a significant public health concern, that if untreated may lead to adverse outcomes for mother, baby and the family unit. The aim of this review was to determine the efficacy of psychological interventions for pregnant women with anxiety in the antenatal period. Although guidelines recommend psychological interventions for managing anxiety in the perinatal period, there is a lack of strong evidence on the most effective psychological intervention for use in the antenatal period. Effective non-pharmacological interventions are an important area that requires significant clinical attention. DESIGN A systematic review of quantitative and qualitative studies was conducted using Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline, Applied Social Sciences Index and Abstracts (ASSIA), Web of Science and PsychInfo. Quality appraisal was performed using The Joanna Briggs Institute (JBI) critical appraisal tool to assess methodological quality on all six included papers. All four RCT's were assessed separately using the Cochrane Risk of Bias Tool. FINDINGS Of the 7278 articles, six quantitative studies were included. The overall results of this review found that mindfulness based interventions are by far the most effective intervention for the treatment of anxiety in the antenatal period. These findings are not in line with current guidance on treatment of women with anxiety in the antenatal period and warrants immediate attention. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Healthcare professionals need to be aware of the potential benefits of mindfulness based interventions in practice. There is some evidence to support their use in the antenatal period, however, there remains insufficient evidence to confidently advocate for their use in practice. Follow-up research needs to be conducted on the efficacy of mindfulness based interventions on women with anxiety in the antenatal period using rigorous RCT's. Education and training of Midwives to help promote and use this intervention is recommended.
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Affiliation(s)
| | | | | | - Annmarie Grealish
- University of Limerick, Limerick, Ireland; King's College London, London, United Kingdom
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191
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Griffen A, McIntyre L, Belsito JZ, Burkhard J, Davis W, Kimmel M, Stuebe A, Clark C, Meltzer-Brody S. Perinatal Mental Health Care In The United States: An Overview Of Policies And Programs. Health Aff (Millwood) 2021; 40:1543-1550. [PMID: 34606347 DOI: 10.1377/hlthaff.2021.00796] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In the United States, mental health conditions are the most common complications of pregnancy and childbirth, and suicide and overdose combined are the leading cause of death for new mothers. Although awareness of and action on perinatal mental health is increasing, significant gaps remain. Screening and treatment are widely recommended but unevenly implemented, and policies and funding do not adequately support the mental health of childbearing people. As a result, treatable perinatal mental health conditions can have long-term, multigenerational negative consequences. This article provides an overview of the perinatal mental health landscape in the United States by identifying serious gaps in screening, education, and treatment; describing recent federal and state policy efforts; highlighting successful models of care; and offering recommendations for robust and integrated perinatal mental health care.
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Affiliation(s)
- Adrienne Griffen
- Adrienne Griffen is the executive director of the Maternal Mental Health Leadership Alliance in Arlington, Virginia
| | - Lynne McIntyre
- Lynne McIntyre is the chief mental health officer at Mammha and a coordinator for Postpartum Support International, in Barcelona, Spain
| | - Jamie Zahlaway Belsito
- Jamie Zahlaway Belsito is the policy director at the Maternal Mental Health Leadership Alliance in Topsfield, Massachusetts
| | - Joy Burkhard
- Joy Burkhard is the executive director of 2020 Mom, in Los Angeles, California
| | - Wendy Davis
- Wendy Davis is the executive director of Postpartum Support International, in Portland, Oregon
| | - Mary Kimmel
- Mary Kimmel is an assistant professor in the Department of Psychiatry, University of North Carolina at Chapel Hill, in Chapel Hill, North Carolina
| | - Alison Stuebe
- Alison Stuebe is a professor in the Department of Maternal-Child Health and the Department of Obstetrics and Gynecology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| | - Crystal Clark
- Crystal Clark is an associate professor in the Department of Psychiatry and Behavioral Sciences and the Department of Obstetrics and Gynecology, Northwestern University, in Chicago, Illinois
| | - Samantha Meltzer-Brody
- Samantha Meltzer-Brody is the department chair in the Department of Psychiatry, University of North Carolina at Chapel Hill
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192
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Zochowski MK, Kolenic GE, Zivin K, Tilea A, Admon LK, Hall SV, Advincula A, Dalton VK. Trends In Primary Cesarean Section Rates Among Women With And Without Perinatal Mood And Anxiety Disorders. Health Aff (Millwood) 2021; 40:1585-1591. [PMID: 34606349 DOI: 10.1377/hlthaff.2021.00780] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Reducing the rate of cesarean sections among women considered at low risk for delivery by that method is a goal of Healthy People 2030. Prior research suggests that perinatal mood and anxiety disorders increase the risk for cesarean section, but data are limited. This cross-sectional study of commercially insured women examined the relationship between perinatal depression and anxiety disorders and primary (first-time) cesarean section rates, using administrative claims data for US in-hospital deliveries from the period 2008-17. Of the 360,225 delivery hospitalizations among 317,802 unique women, 24.0 percent included a delivery by primary cesarean section, and 3.1 percent carried a diagnosis of depression, anxiety, or both made during the index pregnancy. Using an adjusted generalized estimating equation, we found that the predicted probability of primary cesarean section was 3.5 percentage points higher, on average, among women with these disorders compared with those without them. Our findings confirm the importance of pursuing research to identify mechanisms by which perinatal depression and anxiety disorders increase the risk for primary caesarean section among women otherwise considered at low risk for delivery by that method, as well as effective interventions.
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Affiliation(s)
- Melissa K Zochowski
- Melissa K. Zochowski is a research specialist in the Department of Psychiatry, University of Michigan, in Ann Arbor, Michigan
| | - Giselle E Kolenic
- Giselle E. Kolenic is a statistician in the Department of Obstetrics and Gynecology, University of Michigan
| | - Kara Zivin
- Kara Zivin is a professor in the Department of Psychiatry, University of Michigan, a research career scientist at the Veterans Affairs Ann Arbor Healthcare System, and a senior health researcher at Mathematica, all in Ann Arbor, Michigan
| | - Anca Tilea
- Anca Tilea is a data and analytics manager in the Department of Obstetrics and Gynecology, University of Michigan
| | - Lindsay K Admon
- Lindsay K. Admon is an assistant professor in the Department of Obstetrics and Gynecology, University of Michigan
| | - Stephanie V Hall
- Stephanie V. Hall is a doctoral student in the Department of Psychiatry, University of Michigan
| | - Agatha Advincula
- Agatha Advincula is a student intern, Benjamin Franklin Scholars, University of Pennsylvania, in Philadelphia, Pennsylvania
| | - Vanessa K Dalton
- Vanessa K. Dalton is a professor in the Department of Obstetrics and Gynecology, University of Michigan
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193
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Trends of Perinatal Stress, Anxiety, and Depression and Their Prediction on Postpartum Depression. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179307. [PMID: 34501906 PMCID: PMC8431252 DOI: 10.3390/ijerph18179307] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 08/25/2021] [Accepted: 08/30/2021] [Indexed: 01/22/2023]
Abstract
Perinatal stress, anxiety, and depression impacts not only women but also their child(ren). The purpose of this longitudinal study is to explore trends of stress, anxiety, and depressive symptoms from pregnancy to postpartum and understand predictions of stress and anxiety on postpartum depression. One-hundred-fifty-six women at 23-28 weeks gestation (T1), 147 at 32-36 weeks gestation (T2), 129 at over 36 weeks gestation (T3), and 83 at postpartum (T4) completed study surveys. The Perceived Stress Scale, Center for Epidemiologic Studies Depression scale, and State-Trait Anxiety Inventory were used to measure stress, depressive symptoms, and anxiety. Descriptive statistics, Pearson and Spearman's correlation, and Generalized Estimating Equation were applied to analyze the data. Results showed that levels of anxiety and depressive symptoms increased from 24 weeks gestation to postpartum, whereas stress levels decreased during pregnancy but increased in postpartum. Over half of women experienced anxiety symptoms, especially during late pregnancy and postpartum. Stress, anxiety, and depressive symptoms were inter-correlated. Notably, women at late pregnancy and postpartum were prone to stress, anxiety, and depression. Prenatal anxiety could predict postpartum depressive symptoms. Active assessment and management of stress, anxiety, and depression is needed and should begin from early pregnancy and continue until postpartum.
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194
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Agako A, Donegan E, McCabe RE, Frey BN, Streiner D, Green S. The role of emotion dysregulation in cognitive behavioural group therapy for perinatal anxiety: Results from a randomized controlled trial and routine clinical care. J Affect Disord 2021; 292:517-525. [PMID: 34147963 DOI: 10.1016/j.jad.2021.05.084] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 04/11/2021] [Accepted: 05/30/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Emotion dysregulation (ED) has been implicated in anxiety disorders and may play an important role in Cognitive Behavioural Therapy (CBT) treatment for perinatal anxiety outcomes although there is a dearth of research in this area. The current study investigated the role of ED in perinatal anxiety treatment outcome to determine whether it impacts CBT treatment outcomes and whether CBT reduces ED. METHODS Secondary analyses were run on a sample of N = 75 women participating in a CBT for perinatal anxiety randomized controlled trial (RCT), and N = 47 women who received the treatment as part of routine clinical care. Participants completed measures of anxiety, depression and ED at baseline, post-CBT/post-waitlist and 3-month follow-up (CBT-RCT group only). MANOVAs were conducted to determine if level of ED moderates treatment outcomes and whether CBT reduces ED. Reliable and clinically meaningful change was calculated. RESULTS Baseline level of ED did not moderate treatment outcomes. There were significant changes in some ED subscales over time in the CBT group compared to waitlist. Changes were reliable and clinically meaningful in 28.6% (RCT) and 16% (routine clinical care) of participants. Participants with high ED at baseline remained in the high range at post-treatment. LIMITATIONS Limitations include low sample size; homogeneity of sample, use of measures not validated in perinatal populations. CONCLUSIONS These findings suggest that ED during the perinatal period may be a stand-alone factor that will need to be separately addressed in psychological treatment.
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Affiliation(s)
- Arela Agako
- Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, ON, Canada; Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, ON, Canada.
| | - Eleanor Donegan
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Randi E McCabe
- Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, ON, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada; Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, ON, Canada
| | - Benicio N Frey
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada; Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, ON, Canada
| | - David Streiner
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada; Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, ON, Canada
| | - Sheryl Green
- Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, ON, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada; Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, ON, Canada
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195
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Drakes DH, Fawcett EJ, Rose JP, Carter-Major JC, Fawcett JM. Comorbid obsessive-compulsive disorder in individuals with eating disorders: An epidemiological meta-analysis. J Psychiatr Res 2021; 141:176-191. [PMID: 34216946 DOI: 10.1016/j.jpsychires.2021.06.035] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 05/05/2021] [Accepted: 06/15/2021] [Indexed: 11/30/2022]
Abstract
The present study aimed to provide a precise, meta-analytic estimate of the prevalence of obsessive-compulsive disorder (OCD) amongst those with a current primary eating disorder (ED) diagnosis, and to isolate its predictors. An online search of PubMed and PsycINFO was conducted with a Boolean search phrase incorporating keywords related to OCD, EDs, comorbidity, prevalence, and epidemiology, complemented by references coded from related review articles and contact with experts in the field. Articles were included if they (a) reported an observational study examining current ED diagnoses, (b) used a semi-structured or structured diagnostic interview for OCD and ED diagnosis, (c) applied DSM or ICD criteria, (d) included adolescent or adult samples (age > 12), (e) included patient or community samples, and (f) reported lifetime or current OCD comorbidity. From the 846 articles identified, 35 lifetime and 42 current estimates were calculated. OCD prevalence was extracted from each study for each ED diagnostic category, along with eleven additional potential moderators. Analyses revealed an aggregate lifetime OCD prevalence of 13.9% CI95% [10.4 to 18.1] and current OCD prevalence of 8.7% CI95% [5.8 to 11.8] across EDs. Moderator analyses revealed the prevalence of and risk for OCD in EDs to be greatest in anorexia nervosa binge-eating purging type (ANBP). Further, OCD is most prevalent amongst patient samples than samples recruited from the community.
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Affiliation(s)
- Dalainey H Drakes
- Department of Psychology, Memorial University of Newfoundland, St. John's, Newfoundland, Canada.
| | - Emily J Fawcett
- Student Wellness and Counselling Centre, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
| | - Julia P Rose
- Department of Psychology, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
| | | | - Jonathan M Fawcett
- Department of Psychology, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
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196
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Perinatal Maternal Mental Health and Breastfeeding Are Associated with Infant and Toddler Sensory Profiles. CHILDREN-BASEL 2021; 8:children8090766. [PMID: 34572197 PMCID: PMC8472735 DOI: 10.3390/children8090766] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 08/30/2021] [Accepted: 08/31/2021] [Indexed: 11/17/2022]
Abstract
Infants’ sensory processing may impact their development and daily functioning in multiple domains, as does the mental health of their mothers. Little research has been conducted exploring the novel construct of sensory processing in relation to maternal mental health and arguably one of the most important co-occupations during this sensitive time (i.e., breastfeeding), which may also be impacted by maternal mental health. Therefore, this study aims to explore associations between maternal mental health, the co-occupation of breastfeeding, and the sensory processing profiles of infants. Specifically, a sample of maternal-offspring dyads was examined from pre-gestation through the infant’s age of 18 months. Mothers completed well-validated and contemporary self-report questionnaires of mental health (i.e., depression and anxiety symptom severity) and sensory processing across time points. Findings yielded statistically significant relationships between maternal prenatal and postnatal anxiety and depression symptom severity and infants’ sensory processing profiles. Further connections were found between infants’ sensory processing profiles and both duration and frequency of breastfeeding. The study provides health care professionals with additional perspectives on how maternal mental health status and breastfeeding may be related to infants’ sensory processing profiles.
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197
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Barger MK. Current Resources for Evidence-Based Practice, July/August 2021. J Midwifery Womens Health 2021; 66:540-547. [PMID: 34338411 DOI: 10.1111/jmwh.13273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 06/29/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Mary K Barger
- Hahn School of Nursing and Health Science, Beyster Institute for Nursing Research, University of San Diego, San Diego, California
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198
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Mood during pregnancy: Trends, structure, and invariance by gestational day. J Psychiatr Res 2021; 140:260-266. [PMID: 34119911 DOI: 10.1016/j.jpsychires.2021.06.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 03/12/2021] [Accepted: 06/04/2021] [Indexed: 11/24/2022]
Abstract
Mood dynamics during pregnancy are important in understanding a critical period of human development, and also as a model for biopsychosocial stress processes. Here, in four large samples of smartphone app respondents (differentiated by time period and number of responses), we modeled mood for each gestational day during the pregnancy period. We aimed to delineate patterns of changes in mood across pregnancy, as well as potential changes in measurement properties across the period. Results indicated that three prominent mood factors - positivity, distress, and irritability - could account for responses in this period, and that changes in measurement properties of mood items across pregnancy were small in magnitude. Mean irritability increased, and positivity decreased, in the first trimester before reversing in direction; there was also some evidence for previously reported U-shaped trends in mood, where negative mood is greatest early in pregnancy, decreases, and then increases again. Results help characterize mood processes at a detailed level during a critical period, and point to directions for future research to explicate causes and effects of mood changes during this time.
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199
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Chivers BR, Garad RM, Moran LJ, Lim S, Harrison CL. Support Seeking in the Postpartum Period: Content Analysis of Posts in Web-Based Parenting Discussion Groups. J Med Internet Res 2021; 23:e26600. [PMID: 34264198 PMCID: PMC8323017 DOI: 10.2196/26600] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 03/10/2021] [Accepted: 05/24/2021] [Indexed: 01/17/2023] Open
Abstract
Background The transition from pregnancy to motherhood is a major developmental phase that can be challenging for both women and their families. For new mothers, the postpartum period is recognized as a critical period for increased risk of both physical and mental health concerns. For this reason, it is imperative that women receive accurate, evidence-based information during this time. Objective This study aims to explore the conversations of new mothers on a web-based parenting forum to investigate what topics or concerns are being discussed. Methods A leading Australian web-based support forum for women before and after birth was used to obtain a sample of posts from the mothers of infants aged 0-12 months. Quantitative data (word frequencies and sentiment analysis) and qualitative data (post content) were extracted from discussion threads and examined to determine sentiments and theoretical storylines. Results In total, 260 posts were sampled. Infant care was the most prominent overarching topic discussed, with feeding and sleep being the most discussed subtopics. Discussions about maternal care were much less frequent but included questions about birth recovery, breastfeeding concerns, and interconception. A pattern of behavior emerged within the posts. This pattern resembled a cycle of learning across five phases: help seeking, solution ideation, testing and skill development, consolidation, and empowerment and improved mental well-being. A dynamic interplay was observed as mothers navigated new concerns or developmental changes. Conclusions Engagement in web-based forums to seek help and support during the postpartum period was common, with infant health and well-being being the primary concerns for new mothers during this time. The identification of a maternal learning cycle within the forum underscores the contributory role of web-based communities in maternal peer social support, information seeking, and early parenting practices.
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Affiliation(s)
- Bonnie R Chivers
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Australia
| | - Rhonda M Garad
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Australia
| | - Lisa J Moran
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Australia
| | - Siew Lim
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Australia
| | - Cheryce L Harrison
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Australia.,Diabetes and Vascular Medicine, Monash Health, Clayton, Australia
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Pentecost R, Latendresse G, Smid M. Scoping Review of the Associations Between Perinatal Substance Use and Perinatal Depression and Anxiety. J Obstet Gynecol Neonatal Nurs 2021; 50:382-391. [PMID: 33773955 PMCID: PMC8286297 DOI: 10.1016/j.jogn.2021.02.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2021] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To evaluate published literature on the associations between perinatal substance use (PSU), perinatal depression and anxiety (PDA), and known maternal-newborn outcomes. DATA SOURCES We conducted a systematic search of health-related databases, including PubMed, CINAHL, MEDLINE, and Embase. Search terms included maternal mental health, substance use, postpartum, opioid, alcohol, methamphetamine, addiction, dependence, pregnancy, depression, and anxiety. STUDY SELECTION We included English-language, peer-reviewed reports of primary research and systematic reviews that were published between 2010 and 2020 and focused on PSU and PDA. We excluded commentaries, nonsystematic reviews, and articles on maternal mental health other than PDA. Fourteen of 379 articles met the inclusion criteria. DATA EXTRACTION We used the Joanna Briggs Institute Review Guidelines to guide extraction of the following data: author(s), year of publication, type of study, country of origin, study sample, targeted substance(s), mental health, key findings, and recommendation(s). DATA SYNTHESIS In studies of PSU, researchers identified a strong association with PDA. Likewise, researchers investigating PDA found a strong association with PSU. Findings from these articles suggest an increasing risk for PSU with increasing severity of PDA, depending on the specific substances of use. Findings also indicated that women with polysubstance use have greater odds for comorbid perinatal mental health conditions. A relationship between PSU and PDA and adverse newborn outcomes, such as low birth weight, was found. CONCLUSION There is a paucity of published research on co-occurring PSU and PDA. However, polysubstance use appears to be associated with the greatest risk for PDA. It is essential to address PSU and PDA together to better understand the effects on maternal and infant outcomes.
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